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Sun Dec 2, 2012, 11:02 AM

Allen Frances and Dismay at the DSM--The debacle in Psychiatry

Allen Frances, the author of this piece, was the gneral editor of DSM-IV and IV-TR. He has been the most outspoken critic of the new edition, the DSM-5, scheduled for release this coming spring.

http://www.psychologytoday.com/blog/dsm5-in-distress/201212/dsm-5-is-guide-not-bible-ignore-its-ten-worst-changes

DSM 5 Is Guide Not Bible- Ignore Its Ten Worst Changes

This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public - be skeptical and don't follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.



1) Disruptive Mood Dysregulation Disorder: DSM 5 will turn temper tantrums into a mental disorder- a puzzling decision based on the work of only one research group. We have no idea whatever how this untested new diagnosis will play out in real life practice settings, but my fear is that it will exacerbate, not relieve, the already excessive and inappropriate use of medication in young children. During the past two decades, child psychiatry has already provoked three fads- a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. The field should have felt chastened by this sorry track record and should engage itself now in the crucial task of educating practitioners and the public about the difficulty of accurately diagnosing children and the risks of over- medicating them. DSM 5 should not be adding a new disorder likely to result in a new fad and even more inappropriate medication use in vulnerable children.



2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.



3) The everyday forgetting characteristic of old age will now be misdiagnosed as Minor Neurocognitive Disorder, creating a huge false positive population of people who are not at special risk for dementia. Since there is no effective treatment for this 'condition' (or for dementia), the label provides absolutely no benefit (while creating great anxiety) even for those at true risk for later developing dementia. It is a dead loss for the many who will be mislabeled.


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Reply Allen Frances and Dismay at the DSM--The debacle in Psychiatry (Original post)
Jackpine Radical Dec 2012 OP
Squinch Dec 2012 #1
Igel Dec 2012 #4
summerschild Dec 2012 #5
ananda Dec 2012 #7
Tafiti Dec 2012 #12
silhouete2 Dec 2012 #13
Gman Dec 2012 #17
Cerridwen Dec 2012 #2
GeorgeGist Dec 2012 #3
summerschild Dec 2012 #8
TM99 Dec 2012 #6
elehhhhna Dec 2012 #9
nolabear Dec 2012 #10
nolabear Dec 2012 #11
pacalo Dec 2012 #14
TM99 Dec 2012 #20
gulliver Dec 2012 #15
SheilaT Dec 2012 #16
jeff47 Dec 2012 #18
SheilaT Dec 2012 #19

Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 11:13 AM

1. Why do I get the sneaking suspicion that for each of these new "disorders" there is a pharma company

waiting to release a lucrative drug?

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 11:41 AM

4. Can't imagine.

The first "new disorder" is to bleed the diagnosing of bipolar disorder. Many of the kids are obviously far from the norm and there's pressure to diagnose them with something. If it's bipolar, then there's pressure to prescribe. But if it's not bipolar, then what is it?

You can think of it as a desire to control something by naming it. Or the need to refer to kids for a variety of purposes by a more neutral, "scientific sounding" classification.

Take the minor cognitive impairment label, for instance. Many old people have no such impairment. Others do, but it's not dementia and not dangerously progressive. If grannie is forgetful, it might be a handy label: It lets caregivers know that she might forget things so they should act and plan accordingly; it lets caregivers and family know that her condition isn't dementia. Pathologizing the condition is sad and should be avoided.

However, people are judgmental and suspicious, always ready to jump on anything and assume the worst, and they make this kind of "diagnosis" necessary.

The really messy one will be Asperger's. So many identity issues are tied up with it for so many people--they sort of are defiantly aspie and defend their condition, and taking away their distinctiveness is a bad thing. Others don't like being lumped in with autism because, well, that's just yucky. Or denigrating. It outdates a lot of laws, or strips away some of the justification for them, and any time a law confers benefits it means there's a cohort of people with a vested interest in defending their services. It means educational programs from EC through higher ed will need to be rewritten, and that has the same problem.

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 11:48 AM

5. BINGO!

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 11:54 AM

7. And even worse, people who will take them..

.. thinking that psychiatric diagnoses and drugs will help them
instead of making them drug dependent addicts dealing with
even more drugs to deal with side effects.

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 12:37 PM

12. Indeed.

For anyone interested in this topic, including the forthcoming DSM, this is a must-read:

"The Crazy State of Psychiatry"] by Marcia Angell, from The New York Review of Books, also featured in the The Best American Essays of 2012.

http://books.google.com/books?id=uAI-t9Ot3vcC&pg=PA6&lpg=PA6&dq=marcia+angell+the+crazy+state+of+psychiatry&source=bl&ots=CFJGcWz86N&sig=W_BUlBvK2wnH2QyM1qZ29ur_dQM&hl=en&sa=X&ei=3o-7UND6Fqq3iwKVsoD4Dw&ved=0CF8Q6AEwCQ#v=onepage&q&f=false

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 01:03 PM

13. Exactly

Not to say that there aren't people who truly have issues and need medication and/or therapy (I"m one of those people). HOWEVER, the things listed seem like normal stuff that people go through and putting them on medication serves no purpose other than to line the pockets of pharmaceutical companies. That is sad.

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Response to Squinch (Reply #1)

Sun Dec 2, 2012, 02:03 PM

17. Yuppers... You got it

But again, it's a guide, not a how-to bible. Judgement has always been the order if the day and that does not change.

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 11:28 AM

2. Playing politics with mental health issues

for "fun and profit." Perhaps they can bring back a version of drapetomania to explain "the problems" of the Occupy Movement, or the people striking at walmart and mcdonalds.

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 11:31 AM

3. Behavior Addictions.

Watch out for careless overdiagnosis of internet and sex addiction and the development of lucrative treatment programs to exploit these new markets
.

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Response to GeorgeGist (Reply #3)

Sun Dec 2, 2012, 11:54 AM

8. Good old American capitalism - it never misses an opportunity


Beef up a problem so you can profit with a "cure".

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 11:51 AM

6. I completely agree

I have been practicing in the field now almost 25 years, and I agree with Dr. Frances on all of these points.

I applaud Dr. Frances for speaking out though sadly, it is too little too late.

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Response to TM99 (Reply #6)

Sun Dec 2, 2012, 12:07 PM

9. thanks and

WELCOME TO DU

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Response to TM99 (Reply #6)

Sun Dec 2, 2012, 12:10 PM

10. Me too, TM99. I'm in the field as well and it puts nasty pressure on us to turn to drugs.

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 12:24 PM

11. Sadly, this puts us practitioners in a terrible bind.

The DSM is a diagnostic tool for an extremely inexact profession. You can't "see" bipolar disorder, or Major Depressive Disorder, but an insurance company can require a diagnosis and refuse payment if it doesn't have one. It also is not unusual these days for an insurance company to question the accuracy of a diagnosis without ever having seen the patient. The insurance company can pressure a therapist to prescribe or second guess the efficacy of non-drug therapy. So if your spouse has died, you have lost your job, your marriage has disintegrated, and you simply cannot regain perspective and find your way to hope again, and to act, then your therapist can feel pressure to give you something that will damp down those actually natural feelings rather than give you the warmth, understanding, practical help, and a relationship dedicated to caring about you as a person and not just a syndrome or an illness. I don't eschew drug therapy when I think it's needed, but sometimes it interferes rather than helps.

BUT, we are liable, and patients, who understandably want a way out and don't appreciate being told that their sadness is a way of reaching out and getting the real human contact they so terribly need, often themselves become angry if encouraged to do so. And they can be scared that they aren't being taken care of, and so become easy pawns in the profit game.

And the disclaimer: I am NOT talking about the very necessary drug interventions that are lifesaving for those who truly need them. But being creative and rambunctious isn't necessarily ADHD, and being sad isn't necessarily depressed, and having mood swings isn't necessarily bipolar disorder. I'm worried as hell about the new DSM too.

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Response to nolabear (Reply #11)

Sun Dec 2, 2012, 01:26 PM

14. My goodness, I wasn't aware of this but I had my suspicions.

This could really mess up patients who have no one (with common sense) to rely upon at home for personal guidance to discourage over-medication.

Damn, the pharmaceutical industry dominates when it comes to tv commercials. Added with this eye-opening article, their powerful lobbyists are clearly setting legal parameters that aren't in the best interest of the patients & their doctors.

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Response to nolabear (Reply #11)

Mon Dec 3, 2012, 12:54 AM

20. Yes, it does indeed

I couldn't agree more with what you say nolabear.

At some point during the last twenty years we, as a profession, have been sold this bill of goods that says an insurance agent in Topeka knows more about my client/patient than I do here face to face with them. We have been told to now treat the 'disease' (the labeled diagnosis) and not the person themselves.

I worked in clinical settings and took insurance for about a decade in my private practice. I went through a major health crisis and did not work for the better part of five years as I went through chemotherapy and then rehabilitation. I made a tough decision two years ago when I started back to work. I no longer take insurance...period. I have returned to my roots and practice somatics and psychodynamic approaches that still view the whole person within their various contexts, be it a marriage, a family, or a society.

If you haven't, check out the Psychodynamic Diagnostic Manual (PDM). It is an alternative used by various analytical therapeutic systems, however, it is very practical even for more 'modern' schools as it views the client as a whole system and not just a collection of symptoms looking for a labeled diagnosis.

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 01:39 PM

15. This is another reason healthcare needs to be nationalized.

The integration of Psychiatry, Big Pharma and Big Health Insurance is a plague on the people. The profit motive needs to be eliminated entirely. The current situation of "P-docs" labeling "illnesses" and automatically prescribing "medicine" is expedient, but barbaric.

Medication can help and can even be a lifesaver. There is no question in my mind. But therapy, family, social support, and, yes, a human-centered approach to society itself are also vital. These are not expedient, not easy to explain, can't be easily managed with IT, and don't come in tangible plastic bottles.

We create a mechanized, programmed society that is more and more anti-human. Then we toss the victims into a network of profit centers. If these people aren't lucky enough to run into someone who cares enough to take the time to understand them, then their brain chemistry can become the uncontrolled variable in a series of semi-competent drug experiments.

And the Pharma industrial complex isn't the only problem. The education system is also biased by money concerns. The bright kid whose parents have no money is weeded out of the "doctor supply chain" early on. Meanwhile, rich parents prop up their mediocre offspring until the rest of us end up with "Dr. Moose."

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Response to Jackpine Radical (Original post)

Sun Dec 2, 2012, 01:48 PM

16. And this:

"Painful experience with previous DSM's teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and 'behavioral addictions' will soon be mislabeled as psychiatrically sick and given inappropriate treatment."

(How is it you get a quote inside a gray box?)

It's already bad enough that physical conditions formerly considered normal have been medicalized and are treated with meds now. Turning other normal conditions into diagnosable and treatment-worthy conditions is scary.

On a personal note, my oldest son has Asperger's. He was always an unusual child and was not diagnosed until he was 18 and halfway through high school. He'll be 30 later this month. I've always been very glad we didn't get the label until he was that old because it kept him from being just his syndrome. This is not to say that others don't benefit from a much earlier diagnosis, but the down side of all of these labels is that sometimes the individual behind the label is lost to sight.

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Response to SheilaT (Reply #16)

Sun Dec 2, 2012, 02:14 PM

18. When you're typing the post

Highlight the text you want to be in the gray box, and click the "excerpt" button.

Like this.


It will put some tags around your text that will put it in a gray box.

Alternatively, if you don't want the gray, use the "blockquote" button.

like this

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Response to jeff47 (Reply #18)

Sun Dec 2, 2012, 02:36 PM

19. Thank you

Thank you
Thank you.

I am highly appreciative.

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