DSM-5™…

Posted on Tuesday 3 January 2012

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 a grateful following 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>
Phrases like "of all the lame-brained…", "you’ve got to be kidding…", or "what were they thinking?" came immediately to mind on reading this most recent post from Dr. Allen Frances in Psychology Today. After pondering for a bit, I still can’t find anything sensible about playing the trademark card on DSM-5™.

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.

The APA bullied Suzy into changing her domain to DXREVISIONWATCH from DSM5WATCH. What have they gained? All I can see is adding to the list of people who will be glad to ignore the DSM-5™ in favor of the International Classification of Diseases [ICD] diagnostic codes and let the DSM-5™ copies gather dust in the APA’s warehouse rather than buy them. But more than the loss of sales, the loss of respect for our profession is rapidly approaching epidemic levels…
  1.  
    SG
    January 3, 2012 | 10:17 PM
     

    Wow Mickey. Just wow!

    I knew the APA was low, but I never thought they’d resort to a SLAPP suit.

    You’re absolutely right. This will just be another nail in the DSM coffin. I’m just amazed at how pea-brained and childish these APA “professionals” are!

  2.  
    Ivan
    January 3, 2012 | 11:40 PM
     

    It’s more than a nail in the DSM coffin. It’s a nail in the APA coffin. The professional values of the APA are now out in the open – it’s all about money.

    These are the same people (Darrel Regier, James Scully, David Kupfer, Alan Schatzberg) who put out a stupid and contemptible smear of Allen Frances for alleged financial of interest.

    Now they put out a stupid and contemptible claim of copyright infringement against a non-commercial website that aims only to promote transparency. I will let the lawyers debate whether something that has not yet been published can be protected by copyright. On its face, it seems dubious to me.

    Get a life, Darrel, James, David, Alan.

  3.  
    January 4, 2012 | 12:17 AM
     

    Just like when GSK bullied Fiddaman for blogging, and others. What a PR FAIL for the APA, this will really drive home the message that it is all about POWER and MONEY just like psychiatry! Way to promote bad customer relations! that is what this is all about. Profit before patients, business before compassion. No wonder so many ppl dislike the psychiatric profession.

  4.  
    Jack Carney
    January 4, 2012 | 8:55 AM
     

    Outrage just a luxury here. Task is to block publication. To quote my old buddy, Joe Hill, “don’t mourn, organize.” Petition now … What’s next?

  5.  
    Rich
    January 4, 2012 | 9:34 AM
     

    Love to see a “60 Minutes” on this story. It is full of the incredible corporate yuck that they often report on. How can we suggest they look into it? Needs national attention that it is just not getting.

  6.  
    WG
    January 4, 2012 | 10:13 AM
     

    It was my initial impression that the new DSM was being opened up for discussion… but now it seems that it’s only so long as they have complete editorial control over it.

    I hope that Suzy has success with the new blog. This kind of stupidity reminds me of the UK website about asteroids that received a legal takedown notice from Atari.. http://www.asteroids.co.uk/atari

  7.  
    Joel Hassman, MD
    January 4, 2012 | 3:44 PM
     

    Just like I have asked before and now, how do any psychiatrists with a conscience and commitment to patient care belong to this organization as of the past 5 or more years? And how do younger members put up with this good ol’ boy attitude of senior members? And will Senator Grassley bring these people in front of him once it is very public that the agenda of DSM 5 is anything other than patient care first? And, will the consequences play out if justice is successful?

    And, who is that damn guy behind the curtain anyway!?

  8.  
    January 4, 2012 | 8:10 PM
     

    I agree with Dr. Hassman. Why are psychiatrists who disagree with the APA’s direction and philosophies still paying their dues to it?

  9.  
    January 4, 2012 | 8:23 PM
     

    We aren’t, at least a lot of us…

  10.  
    January 4, 2012 | 11:45 PM
     

    I dropped out of the APA in ’98 because of their nefarious associations even then. Nothing could compel me to rejoin. I had already decided amidst all of the developing controversy surrounding the DSM revision to alternatively use ICD codes for diagnostic purposes. Your article has served to further solidify my commitment to do so. I will share it with my colleagues in the hope that we will participate in a unified boycott of DSM-5 upon its arrival…persona non grata!

  11.  
    January 6, 2012 | 8:59 PM
     

    Public trust or cash cow?
    I’m goin’ with “cash cow.”

    Duane

  12.  
    January 7, 2012 | 9:04 AM
     

    WOW! AMEN TO THIS ENTIRE POST! FINALLY A PSYCHIATRIST WITH BRAINS, EXTENSIVE KNOWLEDGE OF THE SUBJECT MATTER, AND ETHICS! As rare as a snowflake in Boca Raton, Florida (the home of MANY retired Psychiatrists!)
    Blessings on YOU Doc! please share your post with me on Facebook at THOMAS HENNESSY, JR. Boca Raton, Florida, OR at rescindinc@gmail.com or go see http://www.rescindinc.org and sign our M.E. Petition! thanks again for your INTEGRITY! WOW xcoxoxo TMH

  13.  
    January 15, 2012 | 4:27 PM
     

    Thanks again, Mickey, for your post on this issue.

    On January 12, Allen Frances published a follow-up on his “DSM5 in Distress” blog, hosted at Psychology Today:

    DSM 5 Censorship Fails
    Support From Professionals and Patients Saves Free Speech

    “Last week I described the plight of Suzy Chapman, a well respected UK patient advocate forced to change the domain name of her website by the heavy handed tactics of the publishing arm of the American Psychiatric Association. The spurious legal excuse was commercial protection of the ‘DSM 5′ trademark; the probable intent was to stifle one of the internet’s best sources of DSM and ICD information. This bullying could not have come at a worse time – just as final decisions are being made on highly controversial DSM 5 proposals and with the third and final draft due for release this spring. This is precisely when a ragged and reckless DSM 5 can most benefit from the widest and most open discussion…”

    Read follow-up blog here:

    http://www.psychologytoday.com/blog/dsm5-in-distress/201201/dsm-5-censorship-fails

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