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.
On the 19th, Jim Gottstein of PsychRights and Matthew Morrissey of Mind Freedom International will lead a several-hours long Occupy APA rally directly across from the Moscone Center where the APA will be meeting. The several speakers who will address rally participants – Leonard Roy Frank; Ted Chabasinski; Chaya Grossberg; Michael Cornwall – will be crossing mics with former President Clinton who, sometime later that afternoon, will deliver the conference’s keynote. Rollin’ out the big dawg for the big bucks. Clinton is sure to attract lots of mainstream media coverage, which will give the APA the chance to put a favorable spin on some of the recent setbacks it’s suffered.
The biggest blow came from an unanticipated source, from the National Institute of Mental Health and its director, Dr. Thomas Insel. On April 29, less than a month before the new DSM’s release, Insel announced that “… it is critical to realize that we cannot succeed if we use DSM categories as the ‘gold standard’ … That is why NIMH will be re-orienting its research away from DSM categories …” Ironically, as Kirk and Kutchins remind us in their scathing critique of the DSM III, the disease classification that Robert Spitzer and colleagues pioneered in DSM III was designed to facilitate research into the biological causes of mental disorders. Its authors soft-soaped the lack of construct validity of their diagnoses and spot-lighted what they contended was a high degree of inter-rater reliability. According to Spitzer, if psychiatrists could agree among themselves about diagnoses and the criteria on which they rested, they would now be free to investigate the underlying, bio-medical etiology. And so the advent of “scientific psychiatry.”
Thirty years later we’re still waiting. Psychiatry has continued to search and continued to promise, in edition after edition of the DSM, that the next edition would be the charm. The decision in 1999 to develop the DSM-5, despite no apparent need for a new manual, was rooted in the APA’s illusion that the discovery of the root causes of mental illness was at hand. Given the work already done – some presumed genetic links – ten years were deemed sufficient to complete what had been started, and publication was projected for 2009. Then pushed back to 2012; and here we are, 2013, and still no root causes. Under the intense scrutiny and barrage of criticism from professionals and the general public, the APA was obliged to admit last December that the sought-for holy grail of “biomarkers” had yet to be found. Hence, Insel’s announcement that NIMH was jettisoning the DSM and any research done with it. From this point on, NIMH will only fund investigations that utilize its own “research framework,” the “Research Domain Criteria (RDoC)”; which, wonder of wonders, is at least ten years away from being operational. To quote Insel, “… we cannot design a system based on biomarkers or cognitive performance because we lack the data … RDoC is a [research] framework for collecting the data needed for a new nosology … Not a clinical tool … a decade-long project that is just beginning…”
If you can follow all this, it means that the NIMH has to collect the data to develop the research tools to do the research; and it will pay good money – some of the $100 million Obama talked about for “brain research” – to get those tools to do that research. Ah, Rube Goldberg would have loved this, circles within circles. And just so you don’t get your hopes up too high, Insel reminds us that “… mental disorders are biological disorders …” More of the same for the next ten, twenty, thirty years.
As if that weren’t enough for the APA to digest, the Division of Clinical Psychology of the British Psychological Society, one of the APA’s principal gadflies, issued a position paper on May 13 that constitutes a direct challenge to the APA and the NIMH. Entitled “Time for a Paradigm Shift,” it calls for “a conceptual system not based on a ‘disease’ model.” Largely ignored in the U.S., save for Lucy Johnstone’s May 12 post on MIA, the Division’s position paper received wide play in the British press – The Observer printed two provocative articles on May 11 and 12, respectively, “Psychiatrists Under Fire in Mental Health Battle,” and “Medicine’s New Battleground: Does Mental Illness Really Exist?” Fortunately for the APA, American professional organizations, made no public comment: “captive,” as Allen Frances would allege; or adrift, as per my telling, on that long and peculiarly American stream, Denial. In any event, the counter-spin has begun. On May 14, Insel and Jeffrey Lieberman, the APA’s president-elect, issued a joint statement, “DSM-5 and RDoC: Shared Interests.” They pledged that the two organizations will “…continue … to work together…; ” conceded that “ … what may be … feasible today for practitioners is no longer sufficient for researchers …;” and agreed that “ … Patients, families and insurers can be confident that effective treatments are available and that the DSM is the key resource …”
To which I can only echo Groucho — “Horsefeathers.”
Fortunately for those of us who can’t be with them, Jim and Matthew and the APA Occupiers will be on the scene to expose the lies and hypocrisy. I’m sure that ‘phone calls, tweets and e-mails of support to those you know will be there will provide them with a sense of our support and solidarity with them. I had been invited to speak at the rally, but, unable to attend, have substituted a statement on behalf of the Committee to Boycott the DSM-5 which will be read to those assembled by Matthew Morrisey. I’ve attached below a copy of the statement, “The APA & The NRA: Two Peas in a Pod.” It not only expresses my solidarity with the APA Occupiers but my frank contempt for two of the foremost supremacist organizations in the United States. Read it and join the Occupiers. And, don’t forget – “Don’t mourn, organize!”
(Please note that the references for Section I above are to be found at the end of Section II below.)
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II — The APA & The NRA: Two Peas in a Pod
Jack Carney, DSW, Coordinator
Committee to Boycott the DSM-5
OCCUPY APA Action
Annual APA Convention, May 19, 2013
Greetings, comrades and occupiers. I regret we can’t be there with you, but, poor substitute, I’ve sent along this statement of support and solidarity that one of the Occupy organizers will share with you.
I’ll begin by saying that the APA deserves all the enmity you can direct its way. You’re in San Francisco to protest the American Psychiatric Association at the time and place of its annual convention – its 166th, by the APA’s count –and to occupy as best you can the time and space it has claimed as its own. Not surprisingly, the APA’s wordsmiths have devised a throat-gagging theme for the convention — Pursuing Wellness Across the Lifespan – and the conference organizers have outdone themselves by inviting as the keynote former President Bill Clinton, otherwise known as the first-husband-in-waiting.
You’ve come at an opportune time, the occasion of the publication by the APA of its new DSM, the DSM-5, the fifth in a series of diagnostic manuals issued by the APA since 1979 that the APA has claimed are rooted in scientific research. In the intervening years, the DSM has become an iconic tome, used by psychiatrists and mental health profesionals throughout the world; relied upon by Big Insurance to adjudicate claims and by Big Pharma to validate the effectiveness of its medications. It is the face of the APA, its universal identifier, its singular accomplishment. It has also attracted unwelcome attention to itself and to the APA — success has its costs.
With each successive DSM since 1979 – DSM-III & III R; DSM-IV & IV TR; and now, DSM-5 – criticism as well as skepticism has increased. With each diagnosis that’s been added, the credibility of the DSM and of the APA has diminished. More and more of us now know that none of the 300 diagnoses that have accumulated over the years and that will populate the DSM-5 has any scientific basis, that the vaunted biomedical model is a sham, a fiction. We’ve also come to see the APA as a shill for Big Pharma and the DSM’s diagnoses as a cover for the prescription of psychoactive medications that are addictive and dangerous and that have succeeded in killing and shortening the lives of thousands of the persons prescribed them.
How very much like the NRA, another organization that has sold itself to corporate interests, in this case to the large gun manufacturers. The NRA sees more guns as the antidote to gun violence. What’s its slogan – a bad guy with a gun can only be stopped by a good guy with a gun? The APA for its part hasn’t seen a psychoactive med it doesn’t like. Wayne La Pierre’s strategy to protect kids in school is to station cops with guns in every school in the country and to arm teachers. The APA has a companion strategy — ferret out potential student killers by increasing school mental health services, identify more ADD kids and prescribe them the necessary sedating medications.
Welcome to 1984 and Big Brother, with half the population somatized. Welcome to the U.S. as an armed police state.
The NRA won’t oppose prohibition of the sales of assault rifles because they’re the biggest money makers for Big Gun. It’s taken to hide its money-grubbing agenda behind two preposterous beliefs that serve it as perfect smokescreens: first, that the 2nd amendment gives citizens a right to own guns and that the Federal government wants to take that right away — nothing like a little paranoia to muddle people’s minds; and second, that only crazy people commit mass murders – if the public wants gun control legislation, do a bait and switch … pass a law increasing mental health funding to keep the crazy folks under control. To no one’s surprise – not mine, not yours, not even that of The New York Times — the mental health lobby has taken the bait and it looks like the APA and the NRA will wind up sharing the same bed.
So where does that leave us and those Americans that seem to have figured this out? It leaves us up against two nine hundred pound gorillas, with not a fraction of their resources. What can we possibly do?
Well as the old Wobbly and my guiding light, Joe Hill, would have said … “Don’t mourn [or feel sorry for yourself], ORGANIZE!” If you want to change or put an end to a system of oppression, disrupt the relationships of those entities that comprise it. The four principals of the national mental health system are Big Government, Big Pharma, Big Insurance and the APA. You’ll notice that I didn’t say BIG APA. That’s because the APA is the most vulnerable of the bunch – rooted in phony science and myths about so-called mental illness; dependent on the three other BIGS for its resources; desperate to sell the new DSM and re-coup its $25 million investment. Which is why it’s selling the new DSM for $200 a pop. Which is why it’s hired Bill Clinton as its chief huckster.
So you’ve picked the right target – a desperate and diminished APA, whose credibility is at its lowest ebb in forty years, thanks to the metaphysics it’s attempting to peddle as science. Your mission – our mission – is to continue to attack its credibility; to question how and why the BIG THREE – GOVERNMENT, INSURANCE, PHARMA – are so willing to invest so much confidence and so much money in such a flawed institution.
But that’s another story, one that we’ll see played out as the four principals and their lesser acolytes kick around next year’s political football, the ICD-10. As for the NRA … ditto. Neither the NRA nor the APA will prevent another Newtown, another Aurora, and folks with diagnoses will again be scapegoated. Putting an end to needless deaths and ruined lives will require life-long commitment and ongoing struggle. I see you all in my mind’s eye …
In the struggle, Jack Carney
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References – Section I:
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Division of Clinical Psychology, British Psychological Society, DCP Position Statement on Classification: “Time for a Paradigm Shift” May 13, 2013,
Doward, Jamie, “Psychiatrists Under Fire in Mental Health Battle” The Observer, May 12, 2013,
Doward, Jamie, “Medicine’s New Battleground: Does Mental Illness Really Exist?”, TheObserver, May 12, 2013,
Frances, Allen, “Does the DSM-5 Have a Captive Audience” Huffington Post, May 16, 2013,
Insel, Thomas, “Transforming Diagnosis” April 29, 2013,
Insel, Thomas, Lieberman, Jeffrey, “Joint APA & NIMH Statement – DSM-5 and RDoC: Shared Interests” May 14, 2013,
Johnstone, Lucy, “UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model” Mad In America, May 12, 2013,
Kirk, Stuart and Kutchins, Herb, The Selling of DSM: The Rhetoric of Science in Psychiatry New York, Aldine, 1992
Spitzer, Robert, DSM III Casebook, American Psychiatric Publications, 1981
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.