America Is Over Diagnosed and Over Medicated: Allen Frances on Huffington Post

January 9, 2012 by

America Is Over Diagnosed and Over Medicated: Allen Frances on Huffington Post #1

Post #125 Shortlink: http://wp.me/pKrrB-1Di

Today, Allen Frances, MD, who chaired the Task Force that had oversight of the development of DSM-IV has published the first of a series of blogs, on Huffington Post, on his concerns for DSM-5.

Huffington Post

Allen Frances | January 9, 2012
Professor Emeritus, Duke University

America Is Over Diagnosed and Over Medicated

“…The really bad news is that the bulk of psychiatry is no longer done by psychiatrists. Psychiatric medicines are most often prescribed by primary care doctors who are always busy and usually under trained in psychiatry. And their diagnostic and treatment decisions are heavily influenced by drug company advertising aimed directly at patients combined with aggressive marketing campaigns aimed at doctors.

“The result is massive overprescription of medicine for off label, untested, and inappropriate indications. Drug companies have more unregulated freedom in the U.S. than anywhere else in the world to push their product where it does not belong. Their success is measured in returns to shareholders, not benefits to patients…”

“…They call them ‘scientific hypotheses’ that can always be tested and corrected after DSM 5 is published. This is dead wrong and dangerously reckless. DSM 5 will have a dramatic effect on peoples lives and everything in it must be certified safe and scientifically sound.

“Final decisions on DSM 5 will be made soon. I will post a series of blogs highlighting its worst proposals and updating the efforts to shoot them down before they can become official…”

Read on here Allen Frances on Huff Po #1

Filed under Allen Frances, American Psychiatric Association (APA), DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-5 Petitions, DSM-V

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

January 6, 2012 by

Pity the poor American Psychiatric Association, Parts 1 and 2: Gary Greenberg

Post #124 Shortlink: http://wp.me/pKrrB-1Ca

On January 03, I reported that the Licensing and Permissions department of American Psychiatric Publishing, A Division of American Psychiatric Association, served me with two “cease and desist” letters, just before Christmas, claiming use of the registered trademark DSM 5 within my site’s subdomain name was improper, in violation of United States Trademark Law, and that my unauthorized actions may subject me to contributory infringement liability including increased damages for wilful infringement.

I was requested to immediately cease and desist any and all use of the DSM 5 mark and that the DSM 5 mark is removed from the domain name http://dsm5watch.wordpress.com/.

Whether American Psychiatric Publishing might be considered to have a case against me or whether the use of the DSM 5 mark within my subdomain name might be found by a court to be legitimate under “fair use” – given that my site is non commercial, carries a clear disclaimer, with no intent to confuse, mislead or misrepresent my relationship with the APA or its publishing arm – I elected to change the site’s URL the following day.

The second letter demanded that I cease and desist immediately any and all use of the “DSM 5 mark” in the domain names of three additional internet platforms.

I do not own any of these three platforms or have any responsibility for them.

Evidently American Psychiatric Publishing’s Licensing and Permissions department omitted to establish ownership before issuing me with “cease and desist” demands and threats of legal action, on behalf of the American Psychiatric Association. I have received no apology nor explanation for their error. (I am not in a position to disclose the content of the second “cease and desist” letter since it relates to matters concerning a third party.)

Allen Frances, MD, professor emeritus at Duke, chaired the Task Force that had oversight of the development of DSM-IV and has been a fierce critic of the revision process towards the forthcoming edition of the Diagnostic and Statistical Manual of Mental Disorders, DSM-5. On Tuesday, Frances publicly supported my position in a commentary published on his DSM5 in Distress blog, hosted at Psychology Today.

Other blogging psychiatrists, allied mental health professionals and the author, Gary Greenberg, are supporting Frances in what they see as a heavy-handed, arrogant, bizarre and politically damaging move on the part of American Psychiatric Publishing’s Licensing and Permissions department in exercising trademark rights and making threats of legal action against a non commercial, responsible UK patient advocate who provides information and publishes commentary around the revision of two internationally used classification systems.

Commentaries from bloggers are being collated in this post:

Media coverage: American Psychiatric Association (APA) ”cease and desist” v DSM-5 Watch website; Legal information and resources for bloggers and site owners

Today, Gary Greenberg, author of Manufacturing Depression, and Inside the Battle to Define Mental Illness, Wired, December 27, 2010, has published a two part article on his website.

Read Part 1 here:

Pity the poor American Psychiatric Association, Part 1

Read Part Two, here, or published below, with the author’s permission:

Pity the American Psychiatric Association, Part 2

Gary Greenberg Blog

http://www.garygreenbergonline.com/

January 5th, 2012

In the last installment, we found out that the APA is trying to thread a camel through the eye of a needle. In their own view, they have to revise the DSM. To do this, they have to address the reification problem – i.e., that many of us, civilians and clinicians alike, have taken the DSM too seriously and treated the disorders it lists as actual diseases rather than fictive placeholders. To address it, they have to admit that it is a problem, and that they don’t have a solution. They have to fix the plane while it is airborne, but they don’t have the tools or the knowhow to do so, and the more it becomes clear that the plane is in trouble, and the more the mechanics are swearing and banging belowdecks, the more likely it is that the passengers will find out and start asking for a quick landing and a voucher on another airline.

So it is very important to try to keep the passengers in the dark as long as possible. Or, to put it another way, the APA has a product to protect, and the best way to do that, from a corporation’s point of view, is to control the narrative, as the pundits say, about the DSM.

Now, even before the recent events, which I’ll get to in a second, I knew this, because last year I wrote an article about the DSM revision for Wired about the argument between Allen Frances and Michael First, the major players in the DSM-IV revision, and Darrel Regier and David Kupfer, their counterparts on DSM-5. The article was no great shakes, just your usual lunchbucket magazine piece, fair and balanced and bland and forgettable as a soy hot dog with French’s mustard on it. I think Frances came out a little better, but that’s because I think he’s closer to the truth of the matter, and, as one of his colleagues has reminded me about a million times, he’s retired, so he can afford to speak truth to power. And the APA sounded at least reasonable in its willingness to acknowledge that the DSM is more provisional than it is generally made out to be.

Anyway, the forgettable magazine piece is in the process of becoming a book which will probably also be forgettable. And so I went back to my transcripts of conversations with the APA/DSM folks and of course found out all the questions I’d failed to ask and the points I’d failed to get clarified. So I emailed the APA pr apparatchicks and asked them to enlighten me. When exactly did the APA stop taking money from the drug companies for their educational programs, and how exactly was the embargo worded? And did I understand Regier correctly about a highly technical point that I won’t bore you with.

Here’s what I got back for a response.

Dear Gary,

We have received several requests from you for access to APA experts and positions on issues related to the DSM for the book you’re writing. I wanted you to know that we will not be working with you on this project. Last year we gave you free access to several of our officers and DSM experts for the article you wrote for Wired. In spite of the fact that we went to considerable lengths to work with you, the article you produced was deeply negative and biased toward the APA. Because of this track record, we are not interested in working with you further as we have no reason to expect that we would be treated any more fairly in your book than we were in the Wired article.

Now, why the APA would want to hand me such first-rate evidence of its own paranoia – and spare me having to listen to their talking points, not to mention preemptively decline to have a crack at responding to my book– is beyond me. It’s as incomprehensible as the letter itself, or at least the part where they complain that I was “biased toward” them. But I gather they think that they will make it harder for me to write my book, that maybe if they don’t cooperate I won’t do it. It is in any event evidence of an awfully thin skin, and of a bunker mentality. More disturbingly, it is evidence that they don’t really take their public trust too seriously. Especially when you contrast this to the National institutes of Mental Health, and its director Tom Insel, of whose work I’ve been much more directly critical, and who took the time to read it, and who still bent over backwards to get me an hour of face time that was cordial and fascinating. It’s enough to make you a fan of the government.

So to the recent events. Suzy Chapman is a patient advocate from the UK. Her website was an excellent compendium of information, archival material, reports, and, yes, criticism of the DSM-5. I have been using it in my research and admiring her tenacity and her fairmindedness. She has opinions but they are way in the background and neither shrill nor strident.

Chapman called her website DSM-5 and ICD Watch: Monitoring the Development of DSM-5, ICD-11 and ICD-10-CM. (The ICD’s are diagnostic systems run by the World Health Organization, and they are also under revision), and her subdomain name was

http://dsm5watch.wordpress.com

She also put in a disclaimer, made it clear that she had nothing to do with APA, that she wasn’t dispensing medical, legal, or technical advice. But that didn’t stop the APA from going after her. Not long after they got their DSM-5 trademark approved, and right before Christmas, they sent her this nice holiday card, which she’s kindly allowed me to post here, with her redactions.

Name: Redacted
Email: Redacted
Message: December 22, 2011

Suzy Chapman

http://dsm5watch.wordpress.com/

RE: DSM 5 Trademark Violation

Dear Ms. Chapman:
It has come to our attention that the website http://dsm5watch.wordpress.com/ is infringing upon the American Psychiatric Association’s trademark DSM 5 (serial number 85161695) and is in violation of federal law by using it as a domain name.

According to our records, the American Psychiatric Association has not authorized this use of the DSM 5 trademark. Consequently, this use of the DSM 5 mark is improper and is in violation of United States Trademark Law. Your unauthorized actions may subject you to contributory infringement liability including increased damages for willful infringement. We request that you immediately cease and desist any and all use of the DSM 5 mark. Furthermore, we request that the DSM 5 mark is removed from the domain name http://dsm5watch.wordpress.com/ . The American Psychiatric Association has a good-faith belief that the above-identified website’s use of the DSM 5 name and marks is not authorized by the American Psychiatric Association, its agents, or the law. I declare under penalty of perjury that the foregoing is true and correct and that I am authorized to act on behalf of the American Psychiatric Association.

Please confirm, within the next ten (10) days of the date of this letter, that you will stop using our trademark in http://dsm5watch.wordpress.com/ , and provide documentation confirming that you have. Any further use will be considered an infringement.

Thank you for your prompt cooperation in resolving this issue.

Very truly yours,

[Redacted]
Licensing and Permissions Manager American Psychiatric Publishing, A Division of American Psychiatric Association
1000 Wilson Boulevard Suite 1825 Arlington, VA 22209
E-mail: Redacted

Chapman, not in a position to fight, complied almost immediately. Her website is now available at

https://dxrevisionwatch.wordpress.com/

where you can also read about this kerfuffle in more detail.

Why the APA would make themselves into a Goliath is not clear to me. The DSM offers Paranoid Personality Disorder, but this episode makes me wish Frances hadn’t shied away from his proposal for a Self-Defeating Personality Disorder. Because it is not clear to me how they win this one. Not that I really care, at least not about the APA’s fortunes, but are they trying to prove Frances right about his recent, somewhat incendiary, claim that the APA no longer deserves the DSM franchise?

I did ask one of the APA’s trustees about this. He wrote:

As for whether the intellectual property angle was driving them to crush the lady in Great Britain or their wanting to crush her because she was being critical, I think when the history is finally known, it will be the former. Maybe we can think of someone using “DSM-5″ who is friendly and note the reaction.

I do like this idea of conducting an experiment. And he may well be correct, that this is the APA worrying about its intellectual property rather than just trying to make Suzy Chapman miserable or squash dissent. Will they go after the sites that have popped up predictably in the wake of publicity of their enforcement action, like www.dsm5sucks.com and the twitter account @dsm5nonsense (whose owner dares the APA to come after them)? But in the meantime, this only proves two points:

First, this organization is at least terribly tone deaf. Going after Suzy Chapman is sort of like Lowe’s yanking its ads from a tv show depicting Muslims as normal people – a hugely blunderous action taken to please a tiny constituency, which can’t possibly earn them anything but scorn and opprobrium. Either they don’t know how they come off or they don’t care. Either way, it’s pretty disturbingly arrogant behavior for an organization that has so much to say about how public money is spent.

Second, the APA is a corporation that, like any other, will do anything to protect itself from harm, real or imagined. And it spends a lot of time imagining dangers. That’s probably because it knows its primary product – the DSM, which accounts for ten percent of its income and a great deal of its clout – is faulty, and it knows that it doesn’t quite know how to fix it without risking making it much much worse.

[Ends]

Legal information and resources for bloggers and site owners:

1] Wipedia article: Cease and desist
http://en.wikipedia.org/wiki/Cease_and_desist

2] Wipedia article: Strategic lawsuit against public participation (SLAPP)
http://en.wikipedia.org/wiki/Strategic_lawsuit_against_public_participation

3] Electronic Frontier Foundation (EFF)
http://en.wikipedia.org/wiki/Electronic_Frontier_Foundation
http://www.eff.org/

EFF Bloggers’ Rights
https://www.eff.org/bloggers

EFF Legal Guide for Bloggers
https://www.eff.org/issues/bloggers/legal

4] Chilling Effects
http://en.wikipedia.org/wiki/Chilling_Effects_(group)
http://chillingeffects.org/

5] U.S. Trademark Law, Rules of Practice & Federal Statutes, U.S. Patent & Trademark Office, November 2011 http://www.uspto.gov/trademarks/law/tmlaw.pdf

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, ICD-11, ICD-11 Alpha Draft Tagged with , , , , , , , , , , ,

Resources and media coverage: American Psychiatric Association “cease and desist” v DSM-5 Watch website

January 4, 2012 by

Post #123 Shortlink: http://wp.me/pKrrB-1Bi

Update: Commentary on APA’s threats of legal action in paper by Dr Monica Greco:

Monica Greco (2016) What is the DSM? Diagnostic manual, cultural icon, political battleground: an overview with suggestions for a critical research agenda, Psychology & Sexuality, 7:1, 6-22, DOI: 10.1080/19419899.2015.1024470

Dr. Monica Greco is a Reader in the Department of Sociology at Goldsmiths, University of London and a Fellow of the Humboldt Foundation. She is the author of Illness As a Work of Thought: A Foucauldian Perspective on Psychosomatics (Routledge, 1998) and of articles on psychosomatics, vitalism, medical humanities and the sociology of unexplained symptoms.

Click to access Greco%20-%20What%20is%20the%20DSM%20for%20GRO.pdf

Media coverage: American Psychiatric Association (APA) “cease and desist” v DSM-5 Watch website;

Legal information and resources for bloggers and site owners

Media coverage and blogger commentaries on “APA ‘cease and desist’ use of DSM 5 mark in domain name” issue

Neurobonkers

APA Shut Down DSM-5 Blogger

Knight Science Journal Tracker

Psychiatrists issue legal threat, silencing blogger critical of diagnostic manual.

Paul Raeburn | March 1, 2012

also

National Association of Science Writers

Reporting on Health

William Heisel’s Antidote

Investigating Untold Health Stories

Part One: February 27, 2012

Slap: American Psychiatric Association Pressures Brit DSM5 Blogger Suzy Chapman

Part Two: February 29, 2012

William Heisel: Slap: American Psychiatric Association Targets One DSM5 Critic, Ignores Others

Psychiatry Update (Australia)

DSM 5 blogger bounces back

Kate Aubusson | January 19, 2012

Behaviorism and Mental Health

An alternative perspective on mental disorders

Philip Hickey, Ph.D.

What’s New? APA Threats, Xanax, Etc.

Philip Hickey  | January 23, 2012

From a Polish blogger, January 16, 2012

From a Spanish psychologist, January 9, 2012

From a Spanish blogger, January 7, 2012

Salty Current

APA bullies blogger

SC (Salty Current) | January 18, 2012

“…I think what we may be witnessing with the broad challenges to the DSM-5 is the beginning of the end for this psychiatric model. Its flaws, failures, and cooptation by corporate interests are becoming more widely known, and it’s unraveling. Efforts at evasion and intimidation like these merely dramatize the process.”

retired doc’s thoughts

James Gaulte

Southwest, United States
Trained in and practiced internal medicine and pulmonary disease
Interests: current state of medicine from a technical and philosophical point of view

American Psychiatric Association “Slapps” down web site critical of DSM5

James Gaulte | January 12, 2012

“Dr. Bernard Carroll, former head of psychiatry at Duke, writing on the blog Health Care Renewal, writes about an interesting conflict between the APA and a former editor of DSM. See here

“Dr. Allen Francis who edited DSM4 has been highly critical of the DSM process and particularly of the yet to be released DSM5. He expresses concern that psychiatry is being practiced less by psychiatrists and more by primary care physicians, who are busy and often not very well trained in managing psychiatric problem and at times strongly influenced by marketing.

“His criticism includes the charge that with the publication of DSM5, not yet released, there will be more patients diagnosed with DMS defined mental conditions as new diagnoses are being added and the criteria for others have been broadened. His comments regarding his view of the problems with DSM were appearing on at least one web site.

“Now the APA, who owns DSM and profits from its publication and use, has sent out a cease and desist threat to the website previously known as “dsm5watch”…”

Full commentary

1 Boring Old Man

1 Boring Old Man | January 16, 2012

“But this is about more than just Suzy’s site, it’s about the worst kind of arrogance – the worst kind because the people at the APA and the APPI don’t seem to have a clue how arrogant they really are.”

Nederlog

Good news: “DSM-5-censorship fails”

Maarten Maartensz M.A. Psy, B.A. Phil | January 14, 2012

Is the American Psychiatric Association a terrorist organization?

Maarten Maartensz M.A. Psy, B.A. Phil | January 04, 2012

Psychology Today

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D. (Chair, DSM-IV Task Force and currently professor emeritus at Duke.)

DSM 5 Censorship Fails
Support From Professionals and Patients Saves Free Speech

Allen Frances, M.D. | January 12, 2012

“Last week I described the plight of Suzy Chapman, a well respected UK patient advocate forced to change the domain name of her website by the heavy handed tactics of the publishing arm of the American Psychiatric Association. The spurious legal excuse was commercial protection of the ‘DSM 5’ trademark; the probable intent was to stifle one of the internet’s best sources of DSM and ICD information. This bullying could not have come at a worse time – just as final decisions are being made on highly controversial DSM 5 proposals and with the third and final draft due for release this spring. This is precisely when a ragged and reckless DSM 5 can most benefit from the widest and most open discussion.”

Read on 

PLoS Blogs

Neuroanthropology

About Neuroanthropology

Neuroanthropology forms part of PLoS Blogs, and is one of eleven founding blogs that joined with PLoS.org, everyONE and Speaking of Medicine to provide a comprehensive network that covers science and medicine…Daniel Lende is Associate Professor in Anthropology at the University of South Florida. He trained in medical, psychological, and biological anthropology and public health at Emory University…

Wednesday Round Up #160

Daniel Lende  | January 11, 2012

“This week I lead off with some controversy over the new edition of the Diagnostic and Statistical Manual, DSM 5, which is due out in 2013. This is not the first time the DSM 5 has come into the public’s eye (it’s been there pretty much since it got announced), but the focus has zoomed in on the machinations of the American Psychiatry Association, the force behind DSM 5, in protecting its DSM 5 brand while also maintaining closed control over the production of the new set of diagnoses.”

Read on here

Mindhacks

Mindhacks | January 07, 2012

The manual that must not be named

Science Isn’t Golden
Matters of the mind and heart
by Paula J. Caplan, Ph.D.

Top Psychiatrists Again Try to Quash Debate
APA shuts down website critical of DSM-5

Paula J. Caplan, Ph.D. in Science Isn’t Golden | January 06, 2012

American Psychiatric Association Shuts Down Critical Website

“As you read the following, think what an outcry there would be if the silencing came from a third-world dictator (or maybe even the U.S. government) and was directed against pro-democracy protestors or protestors against any real harm.”

Thought Broadcast

Two New Ways To Get Sued

Steve Balt, MD | January 06, 2012

“The last week hasn’t been a very uplifting one for psychiatrists who pay attention to the news. For as much as we complain about shrinking reimbursements, the undue influence of Big Pharma, and government meddling in our therapeutic work, we psychiatrists now have two new reasons to be concerned.

“And, maybe, to lawyer up.

“I. APA Threatens Blogger
Most readers who follow this blog will certainly have seen this story already, after first being reported in Allen Frances’ Psychology Today blog. So I know I’m just preaching to the choir here, but frankly, in my opinion, this story cannot receive too much attention.”

Gary Greenberg

About the author

Gary Greenberg Blog

http://www.garygreenbergonline.com/

Pity the poor American Psychiatric Association, Part 1

Pity the poor American Psychiatric Association, Part 2

Gary Greenberg | January 05, 2012

“Why the APA would make themselves into a Goliath is not clear to me. The DSM offers Paranoid Personality Disorder, but this episode makes me wish Frances hadn’t shied away from his proposal for a Self-Defeating Personality Disorder. Because it is not clear to me how they win this one.”

Beyond Meds
Alternatives to psychiatry

APA for DSM5 takes legal action against a website with the URL: http://dsm5watch.wordpress.com/

giannakali | January 04, 2012

“Seems to me the APA is feeling the heat and digging themselves in even deeper.”

I Speak of Dreams

Passions: Effective parenting and education, learning disabilities, non-profit management, horses, and fun!

Yet More Legal Thuggery, This Time from the American Psychiatric Association

I Speak of Dreams | January 05, 2012

“I am not an attorney or in any way educated in the legal system, but this seems to me to be intimidation, pure and simple.”

Behavioral.net

1984 Revisted, II: Big Brother on the Run

“The American Psychiatric Association keeps on undermining its credibility, or more to the point, plays a mean big brother.”

Jack Carney, DSW | January 04, 2012

Hooked: Ethics, Medicine and Pharma blog

Updates and Commentary related to HOOKED: ETHICS, THE MEDICAL PROFESSION, AND THE PHARMACEUTICAL INDUSTRY, by Howard Brody, MD, PhD (Rowman and Littlefield, January, 2007)

From Health Care Renewal: Egregious Behavior of the APA

Howard Brody | January 04, 2012

“Dr. Carroll makes a number of on-target observations in his post. He notes that this action by the APA amounts to what’s called “SLAPP,” which as I discussed in HOOKED means “strategic lawsuit against public participation.” In this case it would be a threatened SLAPP rather than a true SLAPP, as no lawsuit was filed, but the fear of having to go up individually against the deep legal pockets of the APA forced the UK blogger to knuckle under promptly.”

The Carlat Psychiatry Blog
Keeping Psychiatry Honest Since 2007

APA Threatens to Sue “dsm5watch” Website

Dan Carlat | January 04, 2012

“It all seems rather heavy-handed to me. After all, the New York Times appears to have no problem with the anti-Times site called TimesWatch. In a democratic society, healthy dissent and debate is part of the package. It may be annoying, but that doesn’t excuse the bullying tactics that the APA has chosen.”

University Diaries

A professor of English describes university life.
Aim: To change things.

The Stalking Cure

Margaret Soltan | January 04, 2012

Health Care Renewal

Addressing threats to health care’s core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.

SELF INFLICTED DAMAGE

“It is bad enough that the APA resorts to this legal artifice to stifle public discussion. When they do it through their lawyers and business entities rather than through their medical and scientific officers, they sink to a lower level yet. The parallels with corporate sleaze that we have discussed so often on this blog are obvious. For shame.”

Bernard Carroll | January 04, 2012

1 Boring Old Man

DSM-5™…

1 Boring Old Man | January 03, 2012

“Phrases like “of all the lame-brained…”, “you’ve got to be kidding…”, or “what were they thinking?” came immediately to mind on reading this most recent post from Dr. Allen Frances in Psychology Today. After pondering for a bit, I still can’t find anything sensible about playing the trademark card on DSM-5™.”

Soulful Sepulcher

Allen Frances, MD- ” I am surprised and saddened by APA’s ill-conceived attempt to restrict Suzy Chapman’s free expression on DSM 5″

Stephanie at Soulful Sepulcher | January 03, 2012

APA Use Restraints on Blogger

SEROXAT SUFFERERS – STAND UP AND BE COUNTED
A blog by Bob Fiddaman

Bob Fiddaman | January 04, 2012

“The field of psychiatry is doing itself no favours by using intimidation tactics against people that criticize their opinion, let’s face it, the whole premise of psychiatry is based on opinion, I’ve not yet seen any scientific evidence of the chemical imbalance the field of psychiatry tout when someone is depressed or has a psychiatric disorder.

“Chapman’s blog can be read at her new web address HERE. Her work/opinion continues to spread, much to the annoyance of the APA who have probably shot themselves in the foot with their intimidation tactics.

“Memo to the APA – Intimidate a blogger and you put them on a pedastal, you highlight what it is that they have to say… here endeth your first lesson in psychology.”

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D (Dr Frances was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.)

Is DSM 5 A Public Trust Or An APA Cash Cow?
Commercialism And Censorship Trump Concern For Quality

Allen Frances, M.D. |  January 03, 2012

“I am surprised and saddened by APA’s ill-conceived attempt to restrict Suzy Chapman’s free expression on DSM 5. It can only be in the service of the equally unworthy goals of censorship and/or commercialism. I simply can’t imagine that anything should ever be kept secret in the preparation of a diagnostic manual and wonder what in Suzy Chapman’s web site could possibly be so frightening to APA.

“Using a trademark to suppress comment is a violation of APA’s public trust to produce the best possible DSM 5. This is another indication that DSM has become too important for public health and for public policy for its revisions to be left under the exclusive control of one professional organization – particularly when that organization’s own financial future is at stake. This basic conflict of interest can be cured only by creating a new institutional framework to supervise the future DSM revisions. Censorship and commercial motivations must not warp the development of a safe and scientifically sound diagnostic manual.”

Read full commentary

Legal information and resources for bloggers and site owners:

1] Wipedia article: Cease and desist
http://en.wikipedia.org/wiki/Cease_and_desist
2] Wipedia article: Strategic lawsuit against public participation (SLAPP)
http://en.wikipedia.org/wiki/Strategic_lawsuit_against_public_participation
3] Electronic Frontier Foundation (EFF)
http://en.wikipedia.org/wiki/Electronic_Frontier_Foundation
http://www.eff.org/
EFF Bloggers’ Rights
https://www.eff.org/bloggers
EFF Legal Guide for Bloggers
https://www.eff.org/issues/bloggers/legal
4] Chilling Effects
http://en.wikipedia.org/wiki/Chilling_Effects_(group)
http://chillingeffects.org/
Chilling Effects FAQ on Trademark Law
http://www.chillingeffects.org/trademark/faq.cgi#QID251
Chilling Effects on Protest, Parody and Criticism Sites
http://www.chillingeffects.org/protest/
5] U.S. Trademark Law, Rules of Practice & Federal Statutes, U.S. Patent & Trademark Office, November 2011: http://www.uspto.gov/trademarks/law/tmlaw.pdf

 

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-5 Petitions, DSM-V, Internet censorship

Psychiatric creep – Erasing the interface between psychiatry and medicine

January 3, 2012 by

Psychiatric creep – Erasing the interface between psychiatry and medicine

Post #121 Shortlink: http://wp.me/pKrrB-1A5

As reported in an earlier post, the third draft of proposals for changes to DSM-IV categories and criteria is delayed because DSM-5 field trials are running behind schedule.

This third and final draft is now expected to be released for public review and comment, “no later than May 2012”, according to DSM-5 Task Force Vice-chair, Darrel Regier, MD [1].

 

DSM-5 Somatic Symptom Disorders

One focus of this site has been the proposals of the DSM-5 Somatic Symptom Disorders Work Group

Proposed criteria, as they stood in May, last year, are set out on the DSM-5 Development site here: http://tinyurl.com/Somatic-Symptom-Disorders

There are two key PDF documents which expand on the proposals as currently posted:

         Disorders Description  Key Document One: “Somatic Symptom Disorders”

         Rationale Document  Key Document Two: “Justification of Criteria — Somatic Symptoms”

 

Erasing the interface between psychiatry and medicine 

 

I first reported on Co-Cure, over two years ago, in May 2009, that the conceptual framework the Somatic Symptom Disorders Work Group was proposing would:

“…allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome.” [2]

(“Somatic” means “bodily” or “of the body”.)

The most recent version of the Somatic Symptom Disorders Disorders description proposals document states:

“This group of disorders is characterized predominantly by somatic symptoms or concerns that are associated with significant distress and/or dysfunction…Such symptoms may be initiated, exacerbated or maintained by combinations of biological, psychological and social factors.”

“These disorders typically present first in non-psychiatric settings and somatic symptom disorders can accompany diverse general medical as well as psychiatric diagnoses. Having somatic symptoms of unclear etiology is not in itself sufficient to make this diagnosis. Some patients, for instance with irritable bowel syndrome or fibromyalgia would not necessarily qualify for a somatic symptom disorder diagnosis. Conversely, having somatic symptoms of an established disorder (e.g. diabetes) does not exclude these diagnoses if the criteria are otherwise met.”

“The symptoms may or may not be associated with a known medical condition. Symptoms may be specific (such as localized pain) or relatively non-specific (e.g. fatigue). The symptoms sometimes represent normal bodily sensations (e.g., orthostatic dizziness), or discomfort that does not generally signify serious disease.” [3]

 

Psychiatric creep

While the media has focused on the implications for introducing new disorder categories into the DSM and lowering diagnostic thresholds for existing criteria, there has been little scrutiny of the proposals of the Somatic Symptom Disorders Work Group.

This Work Group has been quietly redefining DSM’s Somatoform Disorders categories with proposals that will have the potential for a “bolt-on” diagnosis of a “somatic symptom disorder” for all medical diseases, whether “established general medical conditions or disorders”, like diabetes or angina, or conditions presenting with “somatic symptoms of unclear etiology.”

These radical proposals for rebranding the Somatoform Disorders categories as Somatic Symptom Disorders and combining a number of existing, little-used categories (somatization disorder, hypochondriasis, pain disorder, and undifferentiated somatoform disorder) under a proposed portmanteau term, Complex Somatic Symptom Disorder (CSSD), and the more recently proposed, Simple Somatic Symptom Disorder (SSSD), which requires symptom duration of as little as one month, have the potential for bringing many thousands more patients under a mental health banner.

Complex Somatic Symptom Disorder (CSSD) criteria are here: http://tinyurl.com/DSM-5-CSSD 

Simple Somatic Symptom Disorder (SSSD) criteria are here: http://tinyurl.com/DSM-5-SSSD

These proposals have the potential for expanding markets for psychiatric services, antidepressants and behavioural therapies, like CBT, for the “modification of dysfunctional and maladaptive beliefs about symptoms and disease, and behavioral techniques to alter illness and sick role behaviors”  for all patients with somatic symptoms, if the clinician decides that the patient’s response (or in the case of a child, a parent’s response) to bodily symptoms and concerns about their health are “excessive”, or the perception of their level of disability “disproportionate”, or their coping styles “maladaptive.”

Under the guise of “eliminating stigma” and eradicating “terminology [that] enforces a dualism between psychiatric and medical conditions” by “de-emphasizing the concept of ‘medically unexplained'”, the American Psychiatric Association appears hell bent on colonising the entire medical field by licensing the potential application of a mental health diagnosis to all medical diseases and disorders.

Continued on Page 2

Filed under American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Functional Somatic Syndrome (FSS), Somatic Symptom Disorder, Somatoform Disorders

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality by Allen Frances

January 3, 2012 by

Is DSM 5 A Public Trust Or An APA Cash Cow? Commercialism And Censorship Trump Concern For Quality

APA forces domain name change for DSM-5 and ICD-11 Watch site

Post #122 Shortlink: http://wp.me/pKrrB-1Ah

3 January, 2012

On December 22, with just one working day left before offices closed down for the Christmas and New Year holidays, I received two communications from the Licensing and Permissions department of American Psychiatric Publishing, A Division of American Psychiatric Association, informing me that the unauthorized use of the DSM 5 mark in my domain name is improper and in violation of United States Trademark Law.

I was advised that my actions may subject me to contributory infringement liability including increased damages for wilful infringement. I was requested to immediately cease and desist any and all use of the DSM 5 mark, remove the DSM 5 mark from my domain name and provide documentation confirming I had done so, and that any further use would be considered an infringement.

Given the difficulties of liaising from the UK with American Psychiatric Publishing and with my Californian based site hosts, WordPress, over the holiday and mindful of the implied consequences should I delay taking action, I considered I had little option but to change the site’s domain and title.

Since December 23, this site has been operating under the title Dx Revision Watch and the site’s domain name has been changed to

https://dxrevisionwatch.wordpress.com/

As a result of changing the domain name, links on websites, forums and social media platforms for posts published prior to December 23 and for pages cached on Google and other search engines before that date will no longer point to this site and will return a “site deleted” or 404 message.

If you have bookmarked or are linking to this site please update your links.

Today, on Psychology Today, Allen Frances, MD, who had chaired the DSM-IV Task Force, has blogged on the actions American Psychiatric Publishing has taken against this site:

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D

Is DSM 5 A Public Trust Or An APA Cash Cow?
Commercialism And Censorship Trump Concern For Quality

Allen Frances, M.D. |  January 03, 2012

http://www.psychologytoday.com/blog/dsm5-in-distress/201201/is-dsm-5-public-trust-or-apa-cash-cow

Published on January 3, 2012 by Allen J. Frances, M.D. in DSM5 in Distress

DSM 5 will have a big impact on how millions of lives are led and how scarce mental health resources are spent. Getting the right diagnosis and treatment can be life enhancing, even life saving. Incorrect diagnosis can lead to the prescription of unnecessary and potentially harmful medication and to the diversion of services away from those who really need them and toward those who are better left alone. Preparing DSM 5 should be a public trust of the highest order.

But DSM 5 is also an enormously profitable commercial venture. DSMs are perpetual best sellers (at least one hundred thousand copies sold every year) netting the American Psychiatric Association yearly profits exceeding five million dollars.

From the very start of work on DSM 5, APA took unprecedented steps to protect its commercial interest – but in the process betrayed its obligation to the public trust. Work group members were recruited only on condition that they first sign confidentiality agreements – thereby squelching the free flow of ideas that is absolutely necessary to produce a quality diagnostic manual. ‘Intellectual property’ has been the priority – a safe, scientifically sound DSM 5 has been the victim.

DSM 5 commercialism and heavy handed censorship have recently assumed a new and troubling form. APA is exercising its ‘DSM 5’ trademark to unfairly stifle an extremely valuable source of information. Suzy Chapman, a patient advocate from England, runs a highly respected and authoritative site providing the best available information on the preparation of both DSM and ICD. Her writings can always be relied upon for fairness, accuracy, timeliness, and clarity. The site has gained a grateful following with over 40,000 views in its first two years.

Ms Chapman recently sent me the following email describing her David vs Goliath struggle with the APA and its disturbing implications both for DSM 5 and for internet freedom:

“Until last week, my website published under the domain name http://dsm5watch.wordpress.com/.

On December 22, I was stunned to receive two emails from the Licensing and Permissions department of American Psychiatric Publishing, claiming that the domain name my site operates under was infringing upon the DSM 5 trademark in violation of United States Trademark Law and that my unauthorized actions may subject me to contributory infringement liability including increased damages for willful infringement. I was told to cease and desist immediately all use of the DSM 5 mark and to provide documentation within ten days confirming I had done so.”

“Given my limited resources compared with APA’s deep pockets, I had no choice but to comply and was forced to change my site’s domain name to https://dxrevisionwatch.wordpress.com.

“Hits to the new site have plummeted dramatically and it will take months for traffic to recover – just at the time when crucial DSM 5 decisions are being made.”

“Was APA justified in seeking to exercise its trademark rights in this situation? Or do APA’s actions fly in the face of accepted internet trademark practice, common sense, and good public relations? I am not a lawyer, but I have made a careful study of ‘U.S. Trademark Law, Rules of Practice & Federal Statutes, U.S. Patent & Trademark Office, November 8, 2011’ and of many other available sources. My conclusion is that APA is making excessive and unwarranted claims for its DSM 5 trademark. Courts have found that using a trademark in a domain or subdomain name is ‘fair use’ if the purpose is non commercial, where there is no intent to mislead, where use of the mark is pertinent to the subject of discussion, and where it is clear that the user is not implying endorsement by, or affiliation with, the holder of the mark.”

“The home page of my site clearly defines its purpose – ‘DSM-5 and ICD-11 Watch – Monitoring the development of DSM-5, ICD-11, ICD-10-CM’ and carries this disclaimer,

‘This site has no connection with and is not endorsed by the American Psychiatric Association (APA), American Psychiatric Publishing Inc., World Health Organization (WHO) or any other organization, institution, corporation or company. This site has no affiliations with any commercial or not-for-profit organization…This site does not accept advertising, sponsorship, funding or donations and has no commercial links with any organization, institution, corporation, company or individual.'”

“It puzzles and worries me that APA would seek to suppress my clearly non commercial resource created only to provide information and commentary on the revision process of two internationally used classifications. My only purpose is to inform interested stakeholders and those patient groups whose medical and social care may potentially be impacted by proposals for changes to diagnostic categories and criteria.”

“There is a paradox here. The APA has promoted its commitment to transparency of process, but has rarely demonstrated it. Much has been made of the posting of drafts for public review and soliciting feedback. But to usefully participate in this process, patients, patient groups, and advocacy organizations need to know about proposed changes and when and by what means they can input comment during public review periods. Now, because of APA’s arbitrary actions, it will be harder for them to find the information they need – just when they most need it.”

I am surprised and saddened by APA’s ill-conceived attempt to restrict Suzy Chapman’s free expression on DSM 5. It can only be in the service of the equally unworthy goals of censorship and/or commercialism. I simply can’t imagine that anything should ever be kept secret in the preparation of a diagnostic manual and wonder what in Suzy Chapman’s web site could possibly be so frightening to APA.

Using a trademark to suppress comment is a violation of APA’s public trust to produce the best possible DSM 5. This is another indication that DSM has become too important for public health and for public policy for its revisions to be left under the exclusive control of one professional organization – particularly when that organization’s own financial future is at stake. This basic conflict of interest can be cured only by creating a new institutional framework to supervise the future DSM revisions. Censorship and commercial motivations must not warp the development of a safe and scientifically sound diagnostic manual.

[ENDS]

References:

1] Legal Guide for Bloggers:
https://www.eff.org/issues/bloggers/legal/liability/IP

2] U.S. Trademark Law, Rules of Practice & Federal Statutes, U.S. Patent & Trademark Office, November 8, 2011: http://www.uspto.gov/trademarks/law/tmlaw.pdf

3] Dx Revision Watch: https://dxrevisionwatch.wordpress.com/

4] Dr Allen Frances MD, former chair, DSM-IV Task Force, blogs at “DSM5 in Distress” on “Psychology Today”: http://www.psychologytoday.com/blog/dsm5-in-distress

5] APA’s DSM-5 Development site: http://www.dsm5.org/Pages/Default.aspx

Suzy Chapman

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-V, Internet censorship

DSM 5 Disorganization, Disarray, and Missed Deadlines Allen Frances, Psychology Today

December 30, 2011 by

DSM 5 Disorganization, Disarray, and Missed Deadlines Allen Frances, Psychology Today

Post #120 Shortlink: http://wp.me/pKrrB-1zt

DSM5 in Distress
The DSM’s impact on mental health practice and research.
by Allen Frances, M.D

DSM 5 Disorganization, Disarray, and Missed Deadlines
Beware The Final Mad Rush

Allen Frances, M.D. |  December 29, 2011

Dr Dayle Jones has become one of the world’s leading experts on DSM 5 and on psychiatric diagnosis. As Chair of the American Counseling Association’s DSM 5 Task Force, she closely follows the DSM 5 process and trenchantly critiques the DSM 5 proposals (see her blogs at http://my.counseling.org/category/dayle-jones/).

Dr Jones just sent me the following alarming email: “DSM 5 keeps missing its own deadlines and the DSM 5 publication date is fast approaching. I am afraid there is insufficient time left for thoughtful preparation or adequate public input. Here’s a brief history of DSM 5’s consistent failure to deliver on time…

…Here’s a brief history of DSM 5’s consistent failure to deliver on time.

On the DSM-5 Field Trials in Academic/Large Clinic Settings: These were originally scheduled to begin in 2009, prior even to the draft proposals being reviewed and vetted by outside mental health professionals. But, after much criticism, the DSM-5 Task Force wisely postponed the start date to June 2010. Unfortunately, the Task Force then came up with an impossibly complicated field trial design that was roundly criticized for missing the relevant questions and having a completely unrealistic timetable…

…On the Routine Clinical Practice Field Trial: I have serious concerns whether this will ever get done…Finally, after these many miscues, the field trials ‘officially’ began in September 2011. In November, APA announced it was extending the field trials to March 2012 in order to recruit more participants. There’s a desperate failure motivating this extension- according to the APA flyer, out of “over 5000 clinicians” eligible to participate, only 195 have completed the training, and a mere 70 (1.4%) are enrolling patients.

This field trial is clearly a total bust.

On The Open Periods For Public Comment: APA has repeatedly bragged about the “unprecedented” open comment periods whereby clinicians can post comments about the DSM-5 proposals online during specified time periods. Ironically, the first comment period in February/April 2010 was initiated only after outside pressure insisted that all proposed revisions be reviewed and vetted by the field before field trials could begin. And, interestingly, very few substantive changes have been made in response to public comments since the first drafts were posted- despite the fact that so many DSM 5 proposals have been so heavily criticized. The final public comment period was originally scheduled for September/October 2011, but has been twice postponed because everything is so far behind- first to January/February 2012 and recently to May 2012. Given this late date, new public feedback will almost certainly have no impact whatever on DSM-5 and appears to be no more than a public relations gimmick…”

…In various blogs since, I have warned that the DSM 5 process has suffered from continued disarray- with constantly missed deadlines, reckless proposals, and a poorly written product. I have long predicted that there would be a headlong and heedless rush at the end to meet the new deadline of May 2013 – with the inevitable mistakes, inconsistencies, and poor quality…

…Given all that is undone and poorly done and the ongoing remarkable state of disarray, the May 2013 publication date for DSM 5 has itself become impossibly premature. In any sensible world there would be yet another year’s delay to clean up the current mess. But because projected DSM 5 publishing profits are essential to the meeting the projected APA budget, May 2013 will almost certainly be the one and only deadline DSM 5 will ever meet. It now seems clear that DSM 5 will be born well before its time in an impossibly ragged and possibly unusable state.

Read full article by Allen Frances on Psychology Today

Filed under Allen Frances, American Psychiatric Association (APA), Criticism of DSM-V, DSM-5, DSM revision process, DSM-5, DSM-5 consultation, DSM-5 draft proposals, DSM-5 in the media, DSM-5 Petitions

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