NY Times on the Debate Over DSM-5


The New York Times reviews the debate, politics, and arbitrariness that has defined history of the new edition of the DSM.

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. This article accepts almost all of psychiatry’s unproven assumptions about “mental illness.” But what just occurred to me is the article’s use of the word “experts” to apparently refer exclusively (at least in this context) to psychiatrists. That needs to be challenged. It accepts that the definition of mental problems psychiatry produces is the final word on the subject – why?

    Exactly who is it who proved that a profession that devotes itself almost exclusively to mental problems as physically caused and physically fixed, should be the ones who can tell the rest of us what “mental illness” is – when they have never yet produced persuasive proof physical causality or physical diagnosis?

    Why should not psychologists, sociologists, anthropologists, social workers, counselors and neurologists have more than equal say in the matter? Among them, they know more about research, psychosocial causes, phenomenological data, and brain science than do psychiatrists. And, unlike psychiatry, their objectivity isn’t obliterated by hundreds of billions of dollar (actually, probably more than a trillion over the last 20 years) from PhARMA.

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    • psychiatry appears to be a second trunk of a severely deformed, crooked tree. They *wish* they were a “branch of medicine” or a “branch of science”. They aren’t. They’re a construct, a creation – not fundamental to the whole. There’s something false and fake about psychiatry.

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    • Not only does the article unquestioningly accept psychiatry’s unproven assumptions, it seems to ignore the obvious fact that the DSM is a collection of opinions strained through a committee process and has no legitimacy. The author writes about it as if it were some sort of scientific document.

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  2. “One of the committee’s most ambitious proposals was perhaps the least noticed: a commitment to update the book continually, when there’s good reason to, rather than once every decade or so in a giant heave. That was approved without much fanfare.”

    The roman numerals have been dropped, next up 5.1 5.2, its what you call a pot boiler. For “update continually” read generate more sales for doing f’all.

    p.s. 5.1 & 5.2 will be crap as well. You heard it here first.

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  3. “DSM 5 Is Guide Not Bible—Ignore Its Ten Worst Changes
    APA approval of DSM-5 is a sad day for psychiatry.

    The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good. Yesterday’s APA approval makes it likely that DSM 5 will start a half or dozen or more new fads which will be detrimental to the misdiagnosed individuals and costly to our society.

    The motives of the people working on DSM 5 have often been questioned. They have been accused of having a financial conflict of interest because some have (minimal) drug company ties and also because so many of the DSM 5 changes will enhance Pharma profits by adding to our already existing societal overdose of carelessly prescribed psychiatric medicine. But I know the people working on DSM 5 and know this charge to be both unfair and untrue. Indeed, they have made some very bad decisions, but they did so with pure hearts and not because they wanted to help the drug companies. Their’s is an intellectual, not financial, conflict of interest that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest, and to be oblivious to the distortions that occur in translating DSM 5 to real life clinical practice (particularly in primary care where 80% of psychiatric drugs are prescribed).

    The APA’s deep dependence on the publishing profits generated by the DSM 5 business enterprise creates a far less pure motivation. There is an inherent and influential conflict of interest between the DSM 5 public trust and DSM 5 as a best seller. When its deadlines were consistently missed due to poor planning and disorganized implementation, APA chose quietly to cancel the DSM 5 field testing step that was meant to provide it with a badly needed opportunity for quality control. The current draft has been approved and is now being rushed prematurely to press with incomplete field testing for one reason only- so that DSM 5 publishing profits can fill the big hole in APA’s projected budget and return dividends on the exorbitant cost of 25 million dollars that has been charged to DSM 5 preparation.

    This is no way to prepare or to approve a diagnostic system. Psychiatric diagnosis has become too important in selecting treatments, determining eligibility for benefits and services, allocating resources, guiding legal judgments, creating stigma, and influencing personal expectations to be left in the hands of an APA that has proven itself incapable of producing a safe, sound, and widely accepted manual.

    New diagnoses in psychiatry are more dangerous than new drugs because they influence whether or not millions of people are placed on drugs- often by primary care doctors after brief visits. Before their introduction, new diagnoses deserve the same level of attention to safety that we devote to new drugs. APA is not competent to do this.” DSM5 in Distress
    The DSM’s impact on mental health practice and research
    by Allen Frances, M.D.


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