Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Science Media Centre DSM-5 press briefing: Comments from research and clinical professionals

Post #141 Shortlink: http://wp.me/pKrrB-1TL

On February 9, psychiatrist, Prof Nick Craddock, and psychologist, Prof Peter Kinderman, discussed the implications of proposals for the next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) at a Science Media Centre press briefing for invited journalists.

There has been significant UK and international media interest in mental health professionals’ concerns for a range of controversial proposals for DSM-5. Press coverage is being collated in this Dx Revision Watch post:

Media coverage of UK concerns over DSM-5 (Science Media Centre press briefing)

Commentaries from Allen Frances, MD, today, on Huffington Post:

Can the Press Save DSM 5 from Itself? 

“…The intense press scrutiny of DSM 5 is really just beginning. I know of at least 10 additional reporters who are preparing their work now for publication in the near future. And many of the journalists whose articles appeared during these last few weeks intend to stay on this story for the duration — at least until DSM 5 is published, and probably beyond. They understand that DSM 5 is a document of great individual and societal consequence — and that its impact and risks need a thorough public airing…”

and Christopher Lane, Ph.D. on Side Effects at Psychology Today

DSM-5 Controversy Is Now Firmly Transatlantic

Why the APA’s lower diagnostic thresholds are causing widespread concern.

“Proposed draft revisions to the DSM, which the American Psychiatric Association recently made available on its website, are stirring major controversy on both sides of the Atlantic…”  Read on

 

Science Media Centre has very kindly given permission to publish, in full, the comments provided by research and clinical professionals for use by the press:

DSM5: New psychiatry bible broadens definitions of mental illness to include normal quirks of personality

10.02.2012

Round-up comments

Tim Carey, Associate Professor at the Centre for Remote Health and Central Australian Mental Health Service, said:

“The DSM does not assist in understanding psychological distress nor in treating it effectively. It does not “carve nature at its joints” as it were. It is a collection of symptom patterns that have no underlying form or structure. It is akin to an anthology of the constellations in the night sky. While it does not assist in understanding or treating psychological distress, it has generated phenomenal revenues for the APA, expanded the market for pharmaceutical companies, assisted in promulgating and maintaining a disease and illness model of psychological suffering, and constrained the focus of research activity. Are these the activities a humane and scientific society should seek to promote?

“The authors of the DSM themselves acknowledge the inadequacy of the DSM diagnostic system.

“On page xxxi of the latest edition of the DSM it states: ‘there is no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or from no mental disorder. There is also no assumption that all individuals described as having the same mental disorder are alike in all important ways’.

“So, according to the DSM authors, the boundaries demarcating ‘schizophrenia’ (for example) don’t separate ‘schizophrenia’ from ‘depression’ (or social phobia or intermittent explosive disorder or post-traumatic stress disorder or …) or (perhaps most importantly) the boundaries don’t separate ‘schizophrenia’ from ‘no schizophrenia’.

“One would have to ask: if the function of creating particular categories is not to separate these categories from each other or from their absence, what exactly are they for?”

David Pilgrim, Professor of Mental Health Policy, University of Central Lancashire, said:

“It’s hard to avoid the conclusion that DSM-5 will help the interests of the drug companies and the wrong-headed belief of some mental health professionals (mainly most psychiatrists, but sadly all too often others as well). Some patients and many relatives also gain some advantages from diagnosis some of the time because it reduces the reality of the complexity of their experiences and their responsibilities within those existential struggles.

“Madness and misery exist but they come in many shapes and sizes and so they need to be appreciated in their very particular biographical and social contexts. At the individual level this should mean replacing diagnoses with tailored formulations, and for research purposes we should be either looking at single symptoms or shared predicaments of those with mental health problems and their significant others. I worry that we risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorised in rigid boxes – in my opinion that would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”

Dr Felicity Callard, Senior Research Fellow, Service User Research Enterprise, Institute of Psychiatry, King’s College London, said:

“The ongoing chaos surrounding the development of DSM-5 has intensified rather than lessened fears that this project is ill-conceived and founded on a weak evidence base. People’s lives can be altered profoundly – and, we should bear in mind, sometimes ruinously – by being given a psychiatric diagnosis. In my opinion, that the architects of DSM-5 are pressing on with such a flawed framework undermines their claim that they wish to produce a DSM that is ‘useful to all health professionals, researchers and patients’.”

Dr Paul Keedwell, Honorary Consultant Psychiatrist and Clinical Lecturer in the Neurobiology of Mood Disorders, Cardiff University, said:

“New findings arising from genetics and brain imaging studies hint at biological mechanisms, and challenge the way we classify disorders: syndromes (like bipolar and unipolar depression) might merge, while others (like “the schizophrenias”) might diverge. However a few more decades will pass before we radically change our existing classifications.

“Where the proposed DSMV is particularly controversial is in its addition of more disorders, like “Apathy Syndrome” and “Disruptive Mood Dysregulation Disorder”, which suggest a worrying trend toward medicalising normal variation in behaviour.

“Every new diagnosis implies a new treatment, suiting vested interests in the health industry. Nothing should enter the final version of DSMV without sound research evidence of the need for professionals to intervene.

“Also, every mental health professional should remember that classification systems are a guide to diagnosis only: they do not necessarily map on to the complex needs of an individual in real practice, and they are definitely not a guide to treatment.”

Allen Frances, Emeritus Professor at Duke University and Chair of the DSM-4 Steering Committee, said:

“DSM 5 will radically and recklessly expand the boundaries of psychiatry by introducing many new diagnoses and lowering the thresholds for existing ones. As an unintended consequence, many millions of people will receive inaccurate diagnosis and inappropriate treatment. Costs include: the side effects and complications of unnecessary medication; the perverse misallocation of scarce mental health resources toward those who don’t really need them (and may actually be harmed) and away from those who do most desperately require help; stigma; a medicalization of normality, individual difference, and criminality; and a reduced sense of personal responsibility. The publication of DSM 5 should be delayed until it can be subjected to a rigorous and independent review, using the methods of evidence based medicine, and meant to ensure that it is both safe and scientifically sound. New diagnoses can be as dangerous as new drugs and require a much more careful and inclusive vetting than has been provided by the American Psychiatric Association. Future revisions of psychiatric diagnosis can no longer be left to the sole responsibility of just one professional organization.”

David Elkins, Professor Emeritus of Psychology, Pepperdine University, Los Angeles, and Chair of the Division 32 Task Force for DSM-5 Reform, said:

“My committee and I remain very concerned the DSM-5, as currently proposed, could result in the widespread misdiagnosis of hundreds of thousands of individuals whose behaviour is within the continuum of normal variation. If this occurs, it means these individuals will be labelled with a mental disorder for life and many will be treated with powerful psychiatric drugs that can have dangerous side effects.

“We are also alarmed that the DSM-5 Task Force seems unresponsive to the concerns of thousands of mental health professionals and dozens of mental health associations from around the world.

“My committee recently asked the DSM-5 Task Force to submit the controversial proposals for review by an outside, independent group of scientists and scholars. Our request was denied.

“My committee launched the Open Letter/Petition Website which has now gathered more than 11, 000 individual signatures and endorsements from more than 40 from mental health associations including 13 other Divisions of the American Psychological Association.”

Dr Kevin Morgan, Senior Lecturer, Department of Psychology, University of Westminster, said:

“The proposed revisions to the diagnosis of schizophrenia i.e. the elimination of subtypes and the use instead of symptom dimensions, is an example of how DSM5 may prove to be more clinically beneficial than the current version of the manual. I wait with great interest to see the final agreed set of changes.”

Til Wykes, Professor of Clinical Psychology and Rehabilitation, Institute of Psychiatry, Kings College London, said:

“The proposals in DSM 5 are likely to shrink the pool of normality to a puddle with more and more people being given a diagnosis of mental illness. This may be driven by a health care system that reimburses only if the individual being treated has a recognised diagnosis – one in the DS manual. Luckily in the UK we have the NHS which treats people on the basis of need, not if they fit a diagnostic system.

“It isn’t just a health care system that is subverted by the spreading of diagnostic labels into normality, research will also be changed. Most research studies that reach the widest readership get published in US journals which will expect these diagnostic labels to have been used.

“We shouldn’t use labels unless we are clear they have some benefit. Saying someone is at risk of a mental illness (in some categories of DSM5) puts a lot of pressure on the individual and their family. When we do not have a good enough prediction mechanism, this is too high a burden.”

Dr David Harper, Reader in Clinical Psychology, University of East London, said:

“The American Psychiatric Association’s revisions of the DSM have become as regular as updates for Microsoft Windows and about as much use. It has facilitated an increasing medicalisation of life (the number of disorders the DSM covers has increased exponentially from its first edition in 1952 to 357 in 2000) and is hugely costly (the text revision of DSM IV made $44m in revenue between 2000 and 2006). The problem is not simply the revisions proposed in DSM 5 but the idea that psychological distress matches its diagnostic categories – people’s experiences of distress cluster in an entirely different manner. This is why most people end up with more than one diagnosis, why the ‘not otherwise specified’ category is massively over-used and why ratings of agreement between psychiatrists continue to be poor. The DSM represents a massive failure of imagination: most clinicians and researchers know the system is flawed but try to convince themselves, despite the evidence, that it aids communication, research and treatment. It does not. The frustrating thing is that there are other viable alternatives – for example, a focus on homogenous experiences of distress would aid research, the use of case formulation would aid treatment. Unfortunately, the pharmaceutical industry can see little profit in either alternative and, instead, continue to swing their considerable weight behind the DSM.”

Richard Bentall, Chair of Clinical Psychology at the University of Bangor, said:

“I share the widespread concerns about the proposed revisions to the DSM diagnostic system. Like earlier editions, this version of the manual is not based on coherent research into the causes or nature of mental illness. For example, it treats ‘schizophrenia’ and ‘bipolar disorder’ as separate conditions despite evidence that this is, at best, an over-simplification. It also looks set to widen some of the diagnostic criteria, for example by removing the grief exclusion from major depression, and by expanding the range of psychotic disorders to include an ‘attenuated psychosis syndrome’ (my own research on this, in press, shows that only about 10% of people meeting the attenuated or prodromal psychosis criteria are likely to go on to develop a full-blown psychotic illness). As there is no obvious scientific added value compared to DSM-IV, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.”

Dr Lucy Johnstone, Consultant Clinical Psychologist, Cwm Taf Health Board, Mid Glamorgan, South Wales, said:

“The DSM debate is all about how we understand mental distress. DSM and the proposed revisions are based on the assumption that mental distress is best understood as an illness, mainly caused by genetic or biochemical factors. It is important to realise that, with the exception of a few conditions such as dementia, there is no firm evidence to support this. On the contrary, the strongest evidence is about psychological and social factors such as trauma, loss, poverty and discrimination. In other words, even the more extreme forms of distress are ultimately a response to life problems. We need a paradigm shift in the way we understand mental health problems. DSM cannot be reformed – it is based on fundamentally wrong principles and should be abandoned.”

Dr Warren Mansell, Reader in Psychology & Clinical Psychologist, University of Manchester, said:

“Contemporary research across genetics, neuroscience, psychology and culture all point to the fact that the majority of psychiatric disorders share the same underlying processes and are treated by very similar interventions. Therefore in further emphasising different categories of mental health problems, DSM5 is heading in completely the opposite direction from the most pioneering research across the field of mental health.”

Simon Wessely, Professor of Epidemiological and Liaison Psychiatry at the Institute of Psychiatry, King’s College London:

“We need to be very careful before further broadening the boundaries of illness and disorder. Back in 1840 the Census of the United States included just one category for mental disorder. By 1917 the American Psychiatric Association recognised 59, rising to 128 in 1959, 227 in 1980, and 347 in the last revision. Do we really need all these labels? Probably not. And there is a real danger that shyness will become social phobia, bookish kids labelled as Asperger’s and so on.”

Professor Sue Bailey, President of the Royal College of Psychiatrists, said:

“We recognise the importance of accurate and prompt diagnosis in psychiatry. The classification system used in NHS hospitals and referred to by UK psychiatrists is the World Health Organisation’s International Classification of Disease (ICD). Therefore, the publication of DSM-V will not directly affect diagnosis of mental illness in our health service.”

The British Psychological Society has released a statement on the DSM-5 which can be found here: BPS Statement on DSM-5

* The fifth edition of The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) will be published in May 2013 by the American Psychiatric Association.

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Practice Central on ICD-10-CM transition; APA Monitor and WHO Reed on ICD-11

Two articles on forthcoming classification systems: the first on ICD-10-CM from Practice Central; the second on ICD-11 from the February 2012 edition of the American Psychological Association’s “Monitor on Psychology”

Post #140 Shortlink: http://wp.me/pKrrB-1Tt

Update: Medicare could delay burdensome rules on doctors | Julian Pecquet, for The Hill, February 14, 2012

“The acting head of the Medicare agency said Tuesday that she is considering giving the nation’s doctors more time to switch to a new insurance coding system that critics say would cost millions of dollars for little gain to patients.

“Marilyn Tavenner, the acting administrator of the Centers for Medicare and Medicaid Services, told a conference of the American Medical Association (AMA) that her agency could delay adoption of the so-called ICD-10 system. Current law calls for physicians to adopt the new codes next year…

“…Speaking to reporters after her prepared remarks, Tavenner said her office would formally announce its intention to craft new regulations “within the next few days.”

ICD-10 Deadline Review Update | Andrea Kraynak, for HealthLeaders Media, February 15, 2012

“Big news regarding the ICD-10-CM/PCS implementation timeline came Tuesday morning during the American Medical Association (AMA) National Advocacy Conference in Washington, DC.”

“Per CMS acting administrator Marilyn Tavenner, CMS plans to revisit the current implementation deadline of October 1, 2013. Tavenner said CMS wants to reexamine the pace of implementing ICD-10 and reduce physicians’ administrative burden, according to an AMA tweet…”

Practice Central: Resources for Practicing Psychologists

Practice Central, a service of the APA Practice Organization (APAPO), supports practicing psychologists in all settings and at all stages of their career. APAPO is a companion organization to the American Psychological Association. Our mission is to advance and protect your ability to practice psychology.

http://www.apapracticecentral.org/update/2012/02-09/transition.aspx

Practice Update | February 2012

Transition to the ICD-10-CM: What does it mean for psychologists?

Psychologists should be aware of and prepare for the mandatory shift to ICD-10-CM diagnosis codes in October 2013

By Practice Research and Policy staff

February 9, 2012—Beginning October 1, 2013 all entities, including health care providers, covered by the Health Insurance Portability and Accountability Act (HIPAA) must convert to using the ICD-10-CM diagnosis code sets. The mandate represents a fundamental shift for many psychologists and other mental health professionals who are far more attuned to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM).

Most psychologists were trained using some version of DSM. For other health care providers, the World Health Organization’s International Classification of Diseases and Related Health Problems (ICD) – which contains a chapter on mental disorders – is the classification standard.

Over the years, efforts to harmonize these two classifications have resulted in systems with similar (often identical) codes and diagnostic names. In fact, even if psychologists record DSM diagnostic codes for billing purposes, payers recognize the codes as ICD-9-CM – the official version of ICD currently used in the United States. Since 2003, the ICD-9-CM diagnostic codes have been mandated for third-party billing and reporting by HIPAA for all…

Read full article here

 

Dr Geoffrey M. Reed, PhD, Senior Project Officer, WHO Department of Mental Health and Substance Abuse, is seconded to WHO through IUPsyS (International Union for Psychological Science). Dr Reed co-ordinates the International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders.

Meetings of the International Advisory Group are chaired by Steven Hyman, MD, Harvard University, Cambridge, MA, a former Director of the National Institute of Mental Health (NIMH) and DSM-5 Task Force Member.

The Department of Mental Health and Substance Abuse will also be managing the technical part of the revision of Diseases of the Nervous System (currently Chapter VI), as it is doing for Chapter V.

February 2012 edition of the American Psychological Association’s “Monitor on Psychology”:

http://www.apa.org/monitor/2012/02/disorder-classification.aspx

Feature

Improving disorder classification, worldwide

With the help of psychologists, the next version of the International Classification of Diseases will have a more behavioral perspective.

By Rebecca A. Clay

February 2012, Vol 43, No. 2

Print version: page 40

What’s the world’s most widely used classification system for mental disorders? If you guessed the Diagnostic and Statistical Manual of Mental Disorders (DSM), you would be wrong.

According to a study of nearly 5,000 psychiatrists in 44 countries sponsored by the World Health Organization (WHO) and the World Psychiatric Association, more than 70 percent of the world’s psychiatrists use WHO’s International Classification of Diseases (ICD) most in day-to-day practice while just 23 percent turn to the DSM. The same pattern is found among psychologists globally, according to preliminary results from a similar survey of international psychologists conducted by WHO and the International Union of Psychological Science.

“The ICD is the global standard for health information,” says psychologist Geoffrey M. Reed, PhD, senior project officer in WHO’s Department of Mental Health and Substance Abuse. “It’s developed as a tool for the public good; it’s not the property of a particular profession or particular professional organization.”

Now WHO is revising the ICD, with the ICD-11 due to be approved in 2015. With unprecedented input from psychologists, the revised version’s section on mental and behavioral disorders is expected to be more psychologist-friendly than ever—something that’s especially welcome given concerns being raised about the DSM’s own ongoing revision process. (See “Protesting proposed changes to the DSM” .) And coming changes in the United States will mean that psychologists will soon need to get as familiar with the ICD as their colleagues around the world…

Read full article here

For more information about the ICD revision, visit the World Health Organization.

Rebecca A. Clay is a writer in Washington, D.C

American Psychiatric Association rejects call for independent review of DSM-5 proposals

American Psychiatric Association rejects psychologists’ call for independent review of controversial DSM-5 proposals

Post #135 Shortlink: http://wp.me/pKrrB-1KF

On January 9, 2012, the Coalition for DSM-5 Reform, an ad hoc committee of the Society for Humanistic Psychology (Division 32 of the American Psychological Association), sent another call to the American Psychiatric Association’s Board of Trustees and DSM-5 Task Force to submit controversial proposals for DSM-5 to independent scrutiny.

American Psychiatric Association president, John Oldham, M.D., issued a response last Friday, January 27.

“…There is in fact no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria for mental disorders. In addition, the posting of the criteria on the www.dsm5.org Web site for an international review; the ongoing consultation and coordination with the WHO Mental Disorder Advisory Group for ICD-11; and the several internal reviews provided by the Scientific Review Committee, a Clinical and Public Health Committee review, and the Task Force as a whole, collectively provide the most far reaching review ever undertaken for any DSM revision…”   

                        John Oldham M.D. President, on behalf of American Psychiatric Association

For a copy of the Coalition’s letter see Post #126: Psychologists call for independent review of DSM-5    

Full response from John Oldham, M.D., on behalf of the American Psychiatric Association, here:

      APA Response on 01.27.12 to Coalition for DSM-5 Reform letter of 01.09.12

 

Text

American Psychiatric Association

1000 Wilson Boulevard
Suite 1825
Arlington, VA 22209
Telephone 703.907.7300
Fax 703.907.1085
Email apa@psych.org
Internet www.psych.org

David N. Elkins, Ph.D.
President
Society for Humanistic Psychology
750 First Street, N.E.
Washington, DC 20002Ͳ4242

January 27, 2012

Dear President Elkins:

We appreciate the January 9, 2012, open letter from you and the members of the Division 32 Open Letter Committee to the American Psychiatric Association and developers of DSM-5 regarding the need for a more thorough external review process in revising the manual.

We echo your desire to ensure that “the proposed DSM-5 is safe and credible.” To that end, the DSM-5 Task Force and Work Groups have been purposefully assembled to include clinicians and researchers with diverse backgrounds and expertise, representing nearly 100 different academic and medical institutions from around the world. Our November 21, 2011, letter to the American Counseling Association provides a more complete listing of the steps we have taken to obtain an independent review of the DSM-5 proposals.

(This can be viewed at: https://dxrevisionwatch.files.wordpress.com/2011/11/apa_letter_to_aca_11-21-11.pdf)

[Ed: URL provided in Dr Oldham’s letter returns 404, substituting file from Dx Revision Watch.]

There is in fact no outside organization that has the capacity to replicate the range of expertise that DSM-5 has assembled over the past decade to review diagnostic criteria for mental disorders. In addition, the posting of the criteria on the www.dsm5.org

Web site for an international review; the ongoing consultation and coordination with the WHO Mental Disorder Advisory Group for ICD-11; and the several internal reviews provided by the Scientific Review Committee, a Clinical and Public Health Committee review, and the Task Force as a whole, collectively provide the most far-reaching review ever undertaken for any DSM revision. However, we recognize that there will not be universal agreement with all of the final decisions made in response to these reviews. As with all scientific classifications applied to clinical practice, research will continue to refine our understanding of these disorders, and revisions to the DSM-5 as a living document will be made after publication of DSM-5 in 2013.

Since there is no “gold standard” for defining mental disorders and many other medical disorders without pathognomonic biological markers, each revision of diagnostic criteria has been seen as the best current set of diagnostic criteria that are meant to be used in clinical practice and tested for their validity. Validity criteria first published by Robins and Guze in 1970 for the Feighner criteria have formed the basic framework for testing the Research Diagnostic Criteria, DSM-III, DSM-III-R, DSM-IV, and the ICD-10. The work groups and the review groups have closely attended to these and an expanded set of validity criteria that are contained in the Guidelines for Making Changes to DSM on the http://www.dsm5.org website: (http://www.dsm5.org/ProgressReports/Documents/Guidelines-for-Making-Changes-to-DSM_1.pdf).

The work groups are accessing more than 30 years of research since the DSM-III was first published in making their recommendations. Some of the proposed changes, such as the inclusion of more dimensional components, have been recommended by members of previous Task Forces and by many participants in the National Institutes of Health-sponsored conference series leading up to the Task Force. We will also have empirical data from our field trials on how these and other proposed changes are working. Final decisions about the revisions will only be made after all of these reviews are completed.

We hope that this additional information is responsive to your members, colleagues, and individuals who use mental health services to clarify that we are undertaking an exceptionally extensive review process involving an international and multidisciplinary clinical and scientific group of experts.

As we continue to refine the proposals for DSM-5 and further progress to development of DSM-5.1 and beyond, we look forward to maintaining an open and ongoing dialogue with your organization, colleagues, and the mental health field at large.

Sincerely,

John M. Oldham, M.D.
President

 

Resources

Coalition for DSM-5 Reform on Dx

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook

Coalition for DSM-5 Reform website

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter    @HumanisticPsych

The Society for Humanistic Psychology on Facebook

Psychologists call for independent review of DSM-5

Psychologists call for independent review of DSM-5

Post #126 Shortlink: http://wp.me/pKrrB-1DC

The Coalition for DSM-5 Reform is calling on the American Psychiatric Association to submit its draft proposals for new categories and criteria for DSM-5 to independent scientific review.

An Open Letter and Petition sponsored by the Society for Humanistic Psychology (Division 32 of the American Psychological Association), in alliance with several other American Psychological Association Divisions, attracted nearly 7000 signatures in its first three weeks. Since launching the petition, on October 22, over 10,300 mental health and allied professionals have signed up with over 40 organizations publicly endorsing the Open Letter.

You can view the Open Letter and iPetition here

Yesterday, January 09, Division 32 Open Letter Committee sent another call to the American Psychiatric Association Board of Trustees and DSM-5 Task Force to submit controversial proposals for DSM-5 to independent scrutiny.

PSYCHOLOGISTS CALL FOR INDEPENDENT REVIEW OF DSM-5

January 9, 2012

ATTENTION:                                                                                                                                                                                    David J. Kupfer, M.D., Chair of DSM-5 Task Force
Darrel A. Regier, M.D., M.P.H., Vice Chair of DSM-5 Task Force
John M. Oldham, M.D., President of the American Psychiatric Association
Dilip V. Jeste, M.D., President-Elect of the American Psychiatric Association
Roger Peele, M.D., Secretary of the American Psychiatric Association

To the DSM-5 Task Force and the American Psychiatric Association:

We appreciate your opening a dialogue regarding the concerns that the Division 32 Open Letter Committee and others have raised about the proposed DSM-5.  Your willingness to do this suggests that both the Task Force and our committee are in basic agreement that we both want the DSM-5 to be empirically grounded, credible to mental health professionals and the public, and safe to use.  In keeping with this spirit of open dialogue, we are writing in regard to what we view as a critically important issue.

You will recall that the Division 32 Open Letter Committee, along with the American Counseling Association, recently asked the DSM-5 Task Force and the American Psychiatric Association to submit the controversial portions of the proposed DSM-5 for external review by an independent group of scholars and scientists who have no ties to the DSM-5 Task Force or the American Psychiatric Association.

As you know, it is common practice for scientists and scholars to submit their work to others for independent review.  We believe it is time for an independent group of scientists and scholars, who have no vested interest in the outcome, to do an external, independent review of the controversial portions of the DSM-5.  We consider this especially important in light of the unprecedented criticism of the proposed  DSM-5 by thousands of mental health professionals, as well as mental health organizations, in the United States and Europe.

Will you submit the controversial proposals in DSM-5 to an independent group of scientists and scholars with no ties to the DSM-5 Task Force or the American Psychiatric Association for an independent, external  review?  

We respectfully ask that you not respond again with assurances about internal reviews and field trials because such assurances, at this point, are not sufficient.  We believe an external, independent review is critical in terms of ensuring the proposed DSM-5 is safe and credible.  If you are unwilling to submit the controversial proposals for external, independent review, we respectfully ask that you provide a detailed rationale for your refusal.  Because the DSM is used by hundreds of thousands of mental health professionals, we are publicly posting this letter and will also post your response.   We believe mental health professionals, along with concerned mental health organizations, in the United States and Europe will be very interested in this important exchange.

Sincerely,

David N. Elkins, PhD,  Chair of the Division 32 Open Letter Committee   Email:  David Elkins

Frank Farley, PhD, Member of Committee
Jonathan D.  Raskin, PhD, Member of Committee
Brent Dean Robbins, PhD,  Member of Committee
Donna Rockwell, PsyD, Member of Committee

Resources
 
 

Open Letter and iPetition

Coalition for DSM-5 Reform on Twitter    @dsm5reform

Coalition for DSM-5 Reform on Facebook

Coalition for DSM-5 Reform website

This initiative is also being covered on

The Society for Humanistic Psychology Blog

The Society for Humanistic Psychology on Twitter    @HumanisticPsych

The Society for Humanistic Psychology on Facebook

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

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

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

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.

https://research.gold.ac.uk/17494/1/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

 

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