Is DSM 5 A Public Trust Or An APA Cash Cow?
Commercialism And Censorship Trump Concern For Quality
Psychology Today: DSM-5 in Distress
by Allen J. Frances, M.D.
January 3, 2012
DSM 5 will have a big impact on how millions of lives are led and how scarce mental health resources are spent. Getting the right diagnosis and treatment can be life enhancing, even life saving. Incorrect diagnosis can lead to the prescription of unnecessary and potentially harmful medication and to the diversion of services away from those who really need them and toward those who are better left alone. Preparing DSM 5 should be a public trust of the highest order. But DSM 5 is also an enormously profitable commercial venture. DSMs are perpetual best sellers [at least one hundred thousand copies sold every year] netting the American Psychiatric Association yearly profits exceeding five million dollars. From the very start of work on DSM 5, APA took unprecedented steps to protect its commercial interest – but in the process betrayed its obligation to the public trust. Work group members were recruited only on condition that they first sign confidentiality agreements – thereby squelching the free flow of ideas that is absolutely necessary to produce a quality diagnostic manual. ‘Intellectual property’ has been the priority – a safe, scientifically sound DSM 5 has been the victim.
DSM 5 commercialism and heavy handed censorship have recently assumed a new and troubling form. APA is exercising its ‘DSM 5’ trademark to unfairly stifle an extremely valuable source of information. Suzy Chapman, a patient advocate from England, runs a highly respected and authoritative site providing the best available information on the preparation of both DSM and ICD. Her writings can always be relied upon for fairness, accuracy, timeliness, and clarity. The site has gained afollowing with over 40,000 views in its first two years. Ms Chapman recently sent me the following email describing her David vs Goliath struggle with the APA and its disturbing implications both for DSM 5 and for internet freedom:
"Until last week, my website published under the domain name http://dsm5watch.wordpress.com/ . On December 22, I was stunned to receive two emails from the Licensing and Permissions department of American Psychiatric Publishing, claiming that the domain name my site operates under was infringing upon the DSM 5 trademark in violation of United States Trademark Law and that my unauthorized actions may subject me to contributory infringement liability including increased damages for willful infringement. I was told to cease and desist immediately all use of the DSM 5 mark and to provide documentation within ten days confirming I had done so." "Given my limited resources compared with APA’s deep pockets, I had no choice but to comply and was forced to change my site’s domain name to http://dxrevisionwatch.wordpress.com. Hits to the new site have plummeted dramatically and it will take months for traffic to recover – just at the time when crucial DSM 5 decisions are being made."…<more>
The DSM Manuals have been widely used as the standard for diagnosis in the Mental Health professions at large, but that is a privilege, not a right. By putting the DSM out there for all to use, it seems to me that it is, by definition, in the public domain – a service to the Mental Health community provided by psychiatry which has both prestige value and economic value to the APA in book sales. The whole approach of the DSM-5™ Task Force – secrecy, confidentiality agreements, focusing on only one aspect of mental illness, and now an aggressive attack on a web-site based on a trivial [and probably unenforceable] trademark claim suggest that the Task Force and APA at large believe that the position of the DSM as the definitive last word in Mental Health diagnosis is assured – a position of power that gives them the right to act like an imperious ruling class. That is hardly the case.
They’re not listening to the music. The neuroscience laden DSM-5™ is already under attack. There are 10,000+ plus signatures on a petition calling for changes and an independent review, widely supported in the community of psychologists [see the top left of this blog]. There are psychiatrists of diverse persuasions criticizing the DSM-5™ Revision from multiple directions. Psychiatry itself is under scrutiny for widespread scandal, emphasizing neuroscience exclusively, over-medication of patients, and rampant conflicts of interest in the financial alliance of many psychiatrists with the pharmaceutical industry. It’s hard to remember a time when a specialty of medicine has been attacked from so many directions on so many issues. This is no time to be arrogantly picking a fight with a legitimate patient’s rights web-site like Suzie Chapman’s DSM-5 Watch for including a four character phrase that is in common use into a domain name. It’s like throwing gasoline on a fire that’s already spreading out of control.