DSM-5

As most readers of this website are aware, there is a great deal of resistance to the soon-to-be-released DSM-5. There is even a Boycott DSM-5 Committee established by Jack Carney, and many people are suggesting that practitioners use the World Health Organization’s (WHO’s) International Classification of Diseases (ICD) instead. In the general context of this debate, I have come across an article by Philip Thomas, M.D. – “Pinball Wizards and the Doomed Project of Psychiatric Diagnosis." Dr. Thomas points out that “…it’s hard to imagine that the criticisms raised about DSM-5 won’t also apply to the ICD.” ...

Recently Nick Stuart, a regular commenter on this website, drew my attention to Dr. Steven Novella. Dr. Novella is a strong supporter of the standard psychiatric system, and routinely refers to those of us who challenge these concepts as “mental illness deniers."(Mental Illness Denial Part I) Nick referred me to some of Dr. Novella’s articles, and I published a brief response. I have been giving these matters some thought, however, and I think the subject matter warrants more attention. This is because Dr. Novella does indeed marshal some compelling arguments in other areas, and also because he routinely condemns us “deniers” as illogical employers of “…semantic misdirection and evasion…” ...

Christopher Lane, author of Shyness: How Normal Behavior Became a Sickness, has a new post, in which he attacks the APA for including somatic symptom disorder (SSD) in the upcoming DSM-5. Dr. Lane quotes from Allen Francis (former DSM guru who has now seen the light) and Suzy Chapman, a UK health advocate. Both of these commentators attack the new “diagnosis” as invalid, unreliable, and potentially over-inclusive. Here are some quotes: ...

Prior to about 1994, childhood bipolar disorder was virtually unheard of. DSM-III-R (1987), in the section on manic episode, states, “…studies indicate that the mean age at onset is in the early 20s. However…a sizable number of new cases appear after age 50.”(p 216) Of course a mean age of onset in the early 20’s could include young children. The section on major depressive episode, however, contains the following: “The average age of onset is in the late 20s, but a major depressive episode may begin at any age, including infancy.” (p 220) ...

Until now, I’ve pretty much steered clear of DSM-5. My reason for this is that the upcoming revision represents, to my mind, a distraction from the central issue, i.e., that the whole notion of mental illness is spurious, destructive nonsense. My position is that the purpose of DSM is to expand psychiatric turf and to legitimize the pushing of mood/behavior-altering pharmaceuticals. In the US (and I believe in most developed countries) you can’t prescribe a drug without a diagnosis. And the APA has never neglected its primary mission in this area. ...

Christopher Lane has a post up on Psychology Today (May 14 2012) called: DSM-5 Is Diagnosed, With a Stinging Rebuke to the APA. About a year ago, the APA announced the new “diagnoses” that they proposed to include in the upcoming DSM-5. This kind of expansion is nothing new. The APA has been engaged in the medicalization of every conceivable human problem for the past 50 or 60 years. But on this occasion, some of their more creative and potentially damaging creations generated a good deal of fairly vocal opposition. The upshot of this is a decision by the APA to drop two of the more contentious “diagnoses:” - “attenuated psychosis syndrome” and “mixed anxiety and depression.” ...

Christopher Lane recently published an interesting article on Psychology Today. The article covers a number of topics, including the APA’s proposal to include “hypersexual disorder” in the upcoming DSM-5. The implications of this proposed “diagnosis” are that if you think about sex too much or engage in sexual activity too much, then you have a mental illness. Back in the 60’s, when I was at college, I would frequently find myself chatting with a group of fellow students on a wide range of topics, including sex. Often someone would cite the old statistic that the average young adult male thinks about sex 171 times a day (or whatever), to which the chorus of replies was always – “no way; it’s much more often than that.” ...

Yesterday I received the following email from a reader. “What’s your stance on eccentricity? How do you relate to the general view in the APA that deviation from cultural norms is pathological? And, have you ever read about David Weeks? I consider myself an eccentric person with many quirks and some fetishes. While I have many friends who share the same interests or many of them, I still feel a little bad about psychiatrists labeling eccentricity with SPD or Schizoid personality disorder. I am 19, and my friends are from the 18-25 years of age, and we share a common love for anime and cartoons. Maybe not always the same but sometimes we share two or more common cartoons. Some of them also are collectors of stuffed animals and figurines like me, and some of them engage in masturbation with those objects as me. ...

There was a nice article in the Lancet last month. The article posed the question: “When should grief be classified as a mental illness?” The author criticized the APA’s draft version of DSM-5 for blurring the distinction and for making it more likely that people in bereavement will be “diagnosed” as depressed and, of course, “treated” with prescription drugs. There has been a good deal of criticism against the APA on this issue, and it is likely that the final version of DSM-5 will reflect some retreat in this matter. ...

Daniel Carlat’s blog carries an interesting item. It seems that a lady named Suzy Chapman started a site called dsm5watch, in which she expressed criticism of the DSM. Well, the APA didn’t like this and sent her a cease and desist letter, claiming that the string “DSM-5” is trademarked, and that she was infringing their rights. She complied, changing the name of her site to dxrevisionwatch. What I find interesting here is that the APA claim to be interested in public comment. I guess as long as it doesn’t get too critical. ...