DSM

On March 4, 2020, the very eminent Allen Frances, MD, published an article in Aeon, which according to its About page is “a digital magazine, publishing some of the most profound and provocative thinking on the web. We ask the big questions and find the freshest, most original answers, provided by leading thinkers on science, philosophy, society and the arts.” The article is called The lure of ‘cool’ brain research is stifling psychotherapy. The central theme is that prior to 1990, the National Institute of Mental Health (NIMH) “appreciated the need for a well-rounded approach [to mental health] and maintained a balanced research budget that covered an extraordinarily wide range of topics and techniques.” However, since 1990, the opening year of the Decade of the Brain, the NIMH has “increasingly narrowed its focus almost exclusively to brain biology – leaving out everything else that makes us human, both in sickness and in health.” ...

Robert Spitzer, MD, the architect of DSM-III (1980), died of heart disease on Christmas Day, 2015, at age 83. Most major media outlets published obituaries in which Dr. Spitzer was praised on the grounds that he had brought scientific rigor to psychiatry by naming and defining the various psychiatric illnesses. Here are a few illustrative quotes: "Dr. Robert L. Spitzer, who gave psychiatry its first set of rigorous standards to describe mental disorders, providing a framework for diagnosis, research and legal judgments — as well as a lingua franca for the endless social debate over where to draw the line between normal and abnormal behavior — died on Friday in Seattle." (New York Times, December 26) ...

According to the APA, intermittent explosive disorder is characterized by angry aggressive outbursts that occur in response to relatively minor provocation. This particular label has an interesting history in successive editions of the DSM. DSM I (1952) Intermittent explosive disorder does not appear as such in the first edition of DSM, but the general concept is clearly discernible in “passive-aggressive personality, aggressive type”: "A persistent reaction to frustration with irritability, temper tantrums, and destructive behavior is the dominant manifestation." (p 37) ...

On October 12, 2014, the eminent psychiatrist Allen Frances, MD, participated in a panel discussion at the Mad In America film festival in Gothenburg, Sweden. After the festival, he wrote an article – Finding a Middle Ground Between Psychiatry and Anti-Psychiatry – for the Huffington Post Blog, summarizing the positions he had discussed at the festival. The article was re-published on MIA on October 26, 2014. The article is ostensibly an attempt to find common ground between psychiatry and its critics, but the piece contains numerous distortions and omissions which I think need to be identified and discussed. ...

INTRODUCTION I recently came across an article titled Diagnosisgate: Conflict of Interest at the Top of the Psychiatric Apparatus, by Paula Caplan, PhD. The article was published in Aporia, the University of Ottawa nursing journal, in January 2015. Aporia is “a peer-reviewed, bilingual, and open access journal dedicated to scholarly debates in nursing and the health sciences.” Dr, Caplan is a clinical and research psychologist, and an Associate at Harvard’s DuBois Institute. She worked as a consultant to the DSM-IV task force in the 1980’s, but resigned from this position after two years. Here’s a quote from her February 2014 post on Mad in America The Great “Crazy” Cover-up: Harm Results from Rewriting the History of DSM: ...

On April 5, Allen Frances MD, published an article on the Huffington Post blog. The title is Can We Replace Misleading Terms Like ‘Mental Illness,’ ‘Patient,’ and ‘Schizophrenia’ It’s an interesting piece, and it raises some fundamental issues. Here are some quotes from the article, interspersed with my comments. "Those of us who worked on DSM IV learned first-hand and painfully the limitations of the written word and how it can be tortured and twisted in damaging daily usage, especially when there is a profit to be had." ...

On March 16, Ronald Pies, MD, published an article in the Psychiatric Times. The article is titled The War on Psychiatric Diagnosis, and the sub-title synopsis on the pdf version reads: “A recent report that argues against descriptive diagnosis in medicine is historically ill-informed and medically naive, in the opinion of this psychiatrist.” Dr. Pies is a very prestigious and eminent psychiatrist. He is a professor of psychiatry at both Syracuse and Tufts. He was the first editor of Psychiatric Times, which, by its own account, provides “News, Special Reports, and clinical content related to psychiatry” for “…psychiatrists and allied mental health professionals who treat mental disorders…Circulation of the monthly print publication is approximately 40,000.” ...

BACKGROUND On December 23, I wrote a post called DSM-5 - Dimensional Diagnoses - More Conflicts of Interest? In the article I sketched out the role of David Kupfer, MD, in promoting the concept of dimensional assessment in DSM-5, and I speculated that at least part of his motivation in this regard might have stemmed from the fact that he is a major shareholder in a company that is developing a computerized assessment instrument. I ended the piece with a general criticism of psychiatry: ...

There’s an interesting post from Duncan Double, MD titled Why does the APA need new editions of DSM? Dr. Double is a psychiatrist and a member of the Critical Psychiatry Network. In his current article, Dr. Double expresses the hope that there won’t be a DSM-6, essentially on the grounds that none of the revisions up to this time has resulted in any increase in validity. So each revision, in effect, replaces an invalid old manual with an invalid new one. ...

BACKGROUND A couple of days ago (June 12) I posted Autism Prevalence Increasing. The article drew attention to a post by Kelly Brogan, MD, called See No Evil, Hear No Evil which had appeared on Mad in America on June 9. Dr. Brogan’s article had cited an alarming increase in the incidence of autism over the past few decades, and mentioned some possible causative factors. I checked the figures against the DSM and CDC prevalence estimates and found they were broadly in line. I mentioned the possibility that diagnostic expansion, particularly as embracing milder presentations, might be a confounding factor, but that given the reported increase (1 in 5000 to 100 in 5000) over 38 years, I expressed the view that this was a bit of a stretch. ...