DSM

Last month (May 31), National Public Radio (NPR) ran an interview on Science Friday with Thomas Insel, MD, Director of NIMH, Jeffrey Lieberman, MD, President of the APA, and Gary Greenberg, PhD, practicing psychotherapist. I didn’t hear the interview, but I have read the transcript. Doctors Insel and Lieberman were spinning the barrage of criticism directed at psychiatry in recent months, while at the same time clinging desperately to the notion that the problems that psychiatrists “treat” are real illnesses. It’s become a familiar theme, and there was nothing new. ...

BACKGROUND On May 15, Peter Kinderman, PhD, of the University of Liverpool, posted an article on DxSummit.org. It was called So…What Happens Next? The gist of the article was that psychiatric “diagnoses” are conceptually spurious, unhelpful, and even hindersome in practice, and discourage practitioners from pursuing genuine explanations for the problems clients bring to their attention. It was an excellent piece, and I did a short post in which I recommended it strongly. ...

Today I received the following email from Emily Underwood, a reporter with Science Magazine. I am a reporter with Science magazine -- after reading your Twitter feed and blog I thought you might be interested in a live video chat I’m hosting this week on the controversy surrounding the DSM V. My guests are Allen Frances of Duke University, William Eaton of Johns Hopkins University, and Frank Farley of Temple University; given their different takes on the subject it promises to be a lively conversation! ...

There’s an interesting article in the NY Times Sunday review. You can see it here. It was written by Sally Satel MD, a psychiatrist, currently a resident scholar at the American Enterprise Institute. The article is called: “Why the Fuss Over the DSM-5?” Dr. Satel’s central point is that psychiatrists only treat symptoms anyway and pay little attention to the DSM. She expresses the belief that the manual’s diagnoses are “…passports to insurance coverage, the keys to special education and behavioral services in school and the tickets to disability benefits.” ...

Well, as I guess everybody knows by now, Dr. Insel has changed his mind. On April 29, he stated that the weakness of DSM “…is its lack of validity.” He went on to express the view that his agency, NIMH, (the US government’s mental health research arm) “…cannot succeed if we use DSM categories…” You can see his full statement here. This statement was widely interpreted as a significant rift between NIMH and the APA. But apparently they’ve made up their differences and are pals again. On May 13, just two weeks after his divorce statement, Dr. Insel and Dr. Lieberman, APA president elect, have issued a joint statement in which they express the belief that the DSM “…represents the best information currently available for clinical diagnosis of mental disorders.” Patients, families and insurers, we are told, “…can be confident that effective treatments are available and that the DSM is the key resource for delivering the best available care.” It’s hard to believe that this is the same DSM that he earlier criticized as lacking validity! ...

BACKGROUND On May 3, 2013, David Kupfer MD (DSM-5 Task Force Chair) responded to Thomas Insel’s April 29th unequivocal attack on the validity and usefulness of DSM. You can see Dr. Kupfer’s response here. Essentially Dr. Insel said that the categories set out in the DSM did not correspond to anything in the real world, and that NIMH would no longer be using these categories as the basis for their research program. This statement did not, however, represent any significant movement away from the biomedical model on the part of NIMH. In fact, if anything, it was a movement towards an even more deeply entrenched medical model. But it was a huge hit on DSM and on the APA, who tout the catalog as the basis to their claim to scientific credibility. ...

BACKGROUND Sam Thompson (University of Liverpool) posted the following tweet on April 27: Can anyone point me to a good, succinct summary of the case for equating mental distress with illness? (serious, non-sarcastic question) On the face of it, this looks like a straightforward question, and one might think that a straightforward answer could be found. But this is not the case, because ultimately it boils down to a matter of definition. And psychiatry is a field where definitions are notoriously fuzzy. MENTAL DISORDER ...

BACKGROUND On April 29, Thomas Insel, Director of NIMH, published a paper called Transforming Diagnosis. You can see it here. Dr. Insel is critical of DSM: "While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each." "The weakness is its lack of validity." This has created quite a stir, in that it appears to support the position of those of us who have been criticizing the DSM on these kinds of grounds for decades. It also suggests a fundamental rift between the NIMH and the APA, two groups who up till now had appeared to be joined at the hip. The article has generated a great deal of comment. So far, there’s been nothing from the APA. ...

I keep two dictionaries on my desk. The first is a 1964 Webster’s; the second is a 2009 Webster’s. This morning I looked up the word “depression” in both books. 1964: n. 1. a depressing or being depressed. 2. a depressed part or place; hollow or low place. 3. low spirits; dejection. 4. a decrease in force, activity, amount, etc. 5. a period marked by slackening of business activity, much unemployment, falling prices and wages, etc. ...

The DSM-5 drafting committee considered including Internet addiction in the upcoming revision, but eventually backed off, at least for now. Apparently they decided to put it in the category “requiring further study.” So it’ll be in DSM-6. Meanwhile, people are being given the “diagnosis” anyway – and of course, the “treatment.” AN ILLUSTRATIVE CASE I’m grateful to Tallaght Trialogue for sending me a link to a recent article in the UK’s MailOnline. It was written by Rebecca Seales and Eleanor Harding. You can see it here. ...