People in roles of power in the mental health system often don’t realize how much complicity they have in actually creating the symptoms they claim are biologically-based in individuals with psychiatric labels. Full Article →
The recent furore surrounding publication of the new DSM has provided a much-needed opportunity to discuss and debate crucial issues about how we make sense of, and respond to, experiences of madness and distress. Many psychiatrists, psychologists and other mental health professionals have expressed their dismay about the dominance and inadequacy of a biomedical model of mental illness. Whilst we share these concerns, welcome these debates and support colleagues that are willing to take a stand, The Hearing Voices Network believes that people with lived experience of diagnosis must be at the heart of any discussions about alternatives to the current system.
Schizophrenia Bulletin publishes a review of published articles that finds the use of schizophrenia subtypes (Catatonic, Disorganized, Paranoid, Residual & Undifferentiated), “while widely used in the past,” has declined over the last 20 years to the point that they should be eliminated from research and “evolving knowledge” on the topic.
As demonstrators outside the Moscone Center in San Francisco protested the invalidity of the just-released DSM-5, and the harm they assert has been done in its name, the APA’s incoming president proclaimed psychiatry’s imminent legitimacy as a medical specialty, saying (paraphrasing John F. Kennedy), “‘On this day let the word go forth from this time and place,’ to consumers to clinicians, to policymakers and providers, to advocates and stakeholders, and to all the members of the APA, that for the field of psychiatry and for the patients that we serve, ‘our time has come.’”
NPR’s Marketplace covers the DSM-5′s rollout, with Allen Frances noting that “financial pressures – like dwindling membership – are forcing the APA to treat the DSM like a cash cow, not a public trust”, and psychiatrist (and MIA blogger) Sandra Steingard commenting that she has advised her agency against buying it. Regardless, Marketplace notes, the APA already has more than $150 million in pre-orders.
Monica Cassani promises to add to Beyond Meds’ chronicle, today and for the next week or so, of emerging coverage on the DSM rollout. Three items so far showcase include yesterday’s Time Magazinearticle that concludes “The symptom-based definition of mental illness also encourages labeling of conditions and disorders in a way that implies far more knowledge of mental disorders than is actually the case”, a press release from Mental HealthEurope announcing “western psychiatry is in crisis”, and the New York Times, which concludes “The media will trumpet the release of the new D.S.M., but practicing psychiatrists will largely regard it as a nonevent. Unfortunately, the same cannot be said for other institutions — insurance companies, state and government agencies, and even the courts — which will continue to imbue the D.S.M. with a precision and an authority it does not have.”
Tomorrow, May 18, the American Psychiatric Association kicks off its 166th annual conference. That same day, its new DSM-5 will be officially published. Given the occurrences of the past couple of weeks, which I’ll review briefly below, some members of the APA might wish tomorrow’s events would go unnoticed. But they won’t. Full Article →
The Economist, in its upcoming edition, says of the DSM “No other major branch of medicine has such a single text, with so much power over people’s lives. And that is worrying. Because in no other branch of medicine is the scientific reality underpinning the pronouncements of doctors so uncertain… the current over-reliance on one point of view in this extremely uncertain science is healthy neither for psychiatry, nor for those it treats.”
I think it’s helpful to see the psychiatric/pharmaceutical complex as being somewhat analogous to one of those large inflatable giants that you sometimes see hovering over car lot sales. Sure, it looks big and powerful, and it really is so long as “we the people” buy its propaganda and its drugs and continue feeding it billions of dollars and continue “bowing down” to its “almighty wisdom.” But its entire foundation consists of a model that simply doesn’t fit the research evidence at all, and quite frankly is propped up by many outright lies. Full Article →
There has been a lot of talk lately about neuroscience and the future of the medical model of “mental illness.” It was made clear, in NIMH director Thomas Insel’s statement, that the DSM is a system of identification and classification of what are deemed disorders within our human experience. This isn’t exactly news to the vast majority of people who have spent even a little bit of time thinking about whether or not psychiatric diagnosis makes sense. Full Article →
Leonard Roy Frank, an early pioneer of the Psychiatric Survivor movement, discusses his lived experience including forced insulin treatments, ECT, and the relationship between non-conformity and psychiatric diagnosis. Full Article →
As co-chair of the Diagnostic Summit Committee of the Society for Humanistic Psychology, I am pleased to announce that today we officially launch the Global Summit on Diagnostic Alternatives (DxSummit.org), an online platform for rethinking mental health. Our goal is to provide a place for a collegial and rigorous discussion of alternative ways to conceptualize and practice diagnosis. Today’s launch is marked by the appearance of our first eight posts. These posts come from a variety of prominent people in the field, each offering a unique perspective on the current state of diagnosis and where we might take things as we move forward. Full Article →
What makes the DSM so pernicious is that it is a cultural document whose influence transcends not only psychiatric practice but also the Western civilization from which it originates. Each revision of the DSM rescripts and reimagines how we make sense of our experiences, reinterprets what thoughts, feelings and behaviors are socially sanctioned, and ultimately what it means to be human. Full Article →
As the medical director of a community mental health center, my colleagues look to me for guidance on how to approach the new edition of the DSM. How many should we buy? How much time should be devoted to staff training? This is my answer. Full Article →
When Thomas Szasz’s name comes up in debates over defining mental illness, it is fairly common to hear people say something along the lines of, “Well, he made some good points, but he was just too extreme.” Yet I am struck by how conversations about DSM-5, being released this month, make the crisp arguments Szasz consistently offered for 50 years just as timely as ever. I’d even go so far as to suggest that a large number of counselors, psychologists, social workers, and psychiatrists pretty much agree with the main tenets of Szasz’s argument, despite their ongoing disclaimers. Full Article →
Calling for a complete overhaul of research into psychiatric diagnosis, Director of the NIMH Thomas Insel writes that “Over the past 18 months, we have tried to define several major categories for a new nosology… It became immediately clear that we cannot design a system based on biomarkers or cognitive performance because we lack the data.” Insel cites the current paradigm’s “lack of validity”, saying that “symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half century as we have understood that symptoms alone rarely indicate the best choice of treatment.”
Tension mounts across the ideological divide as D-Day (DSM-5 Day) approaches. The APA has powerful allies on its side. President Obama has just launched Decade of the Brain 2 with the announcement two weeks ago that heralds the arrival of BRAIN ( Brain Research through Advances in Innovative Neurotechnologies). If that’s not enough, those who believe that science will ultimately explain madness can always rely on the media to fawn at their feet. Full Article →
Gary Greenburg writes in the New Yorker that “The D.S.M. has enormous impact on the public health. It determines which conditions insurers will cover, which drugs regulators will approve, which children will receive special-education services, and which criminal defendants will be able to stand trial and, in some cases, how they will be sentenced. Psychiatry has already reached far into our daily lives, and it’s not by virtue of the particulars of any given D.S.M. It’s because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.”
I am returning to the subject of psychological formulation after rather a lengthy gap, during which controversy about the forthcoming 5th edition of DSM has continued to grow – sign the petition ‘Stop the Insanity’ at www.dsm5response.com if you share others’ concerns about the creeping medicalisation of everyday life and the risks that it poses. Full Article →
Saying that he had been “unclear”, Ronald Pies, whose letter to the NY Times Sunday Dialogue occasioned much response therein and herein, goes on to say that “many comments in the blogosphere ranged from the dismissive to the abusive. Predictably, some critics trotted out the old war horses of anti-psychiatry… psychiatry is not ‘scientific,’ because it doesn’t have verifiable laboratory tests or biomarkers for its disorders; psychiatric diagnoses are just the ‘subjective impressions’ of the clinician; psychiatry amounts to ‘totalitarian oppression,’ etc.”
The American Journal of Psychiatry (January, 2103) recently published a series of articles that analyzed the outcomes of the field trials that were conducted by the DSM-5 Task Force, to determine the inter-rater reliability of the multiple diagnostic categories that will comprise the DSM-5. A table below tracks the downward progression of inter-rater reliability from DSM-III through DSM-5. Full Article →
Letters from MIA bloggers Sera Davidow and Laura Delano appear in the New York Times‘ Sunday Dialogue today, responding to Ronald Pies commentary about diagnosis and the DSM-5. A few letters from MIA readers and bloggers that the Times chose not to run appear below.
In a “Personal View” article published yesterday in the British Medical Journal, Allen Frances expresses concern that a “poorly tested” condition included in the DSM-5, “Somatic Symptom Disorder”, lacks specificity and will result in “mislabeling a sizable proportion of the population as mentally ill.”