two lessons…

Posted on Saturday 25 February 2012

Dr. Frances’ most recent post quotes former Journalist now PsyD Donna Rockwell giving tips about how activism ought to work, how to apply leverage where it’s needed right out in the open – engaging people who matter, relying only on the merit of the argument and appealing to their "better sides" through education. Just reading through it, there are not only great ideas, but you also get a sense that she’s a person who knows what she’s talking about and gets things done – a strong lesson from a pro.

But there’s another lesson here. Dr. Allen Frances has pulled off something akin to a miracle himself. He started his campaign reluctantly in 2009, seeing the writing on the wall about the ill-fated DSM-5. And he was right on target about what he saw. He began his campaign in a very public but surprising place – Psychology Today, and then he cross posted in the Psychiatric Times. He talked to any reporter or media person that would listen to him. When he was attacked by the APA President and DSM-5 Task Force Chairs [Setting the Record Straight: A Response to Frances Commentary on DSM-V], he shook it off and stayed on task. Although himself a solid citizen in the halls of psychiatric academia, he’s stepped out and engaged the rest of our mental health colleagues with appropriate respect and humility – as equals in a common cause. Now he’s writing in the Huffington Post, appealing to an even wider audience and has introduced us all to Suzy Chapman, another powerhouse [and lots of others]. If he’s played unfairly in his two and a half year campaign, I don’t know about it.

So there are two lessons here – one from Donna Rockwell and another from Allen Frances. There’s more to bringing about change than simply seeing that it’s needed. As my Dad used to say, "If you’re going to do something, do it right or don’t do it at all." Dr. Frances is doing it right:
Is Government Intervention Needed to Prevent an Unsafe DSM-5?
Huffington Post
by Allen Frances

Donna Rockwell, Psy.D. was once a CNN reporter covering Capitol Hill. She is now a psychologist and a member of the petition committee calling for an independent scientific review of DSM-5. With her journalist’s instinct for the crux of any story, Dr. Rockwell has focused on increasing public scrutiny of DSM-5. She hopes to stimulate government intervention to ensure that DSM 5 meets its public trust. Dr Rockwell sent this email on Feb. 17:

    You recently described the press as the one last hope to ensure that DSM 5 will be safe and sound. While I certainly agree that the press can do a great deal, there is an additional last hope you didn’t mention, one that could be even more powerful. Don’t discount the role of government intervention as a way of influencing the American Psychiatric Association.

    I am currently networking on Capitol Hill and also with the Department of Defense and with the Veterans Administration. My goal is to increase awareness of the risks of DSM-5 and to recruit government assistance in forcing APA to abandon dangerous suggestions. I tell government officials that DSM 5 will have a big impact on many important public health and public policy decisions that will directly affect their constituents. My short list includes: [1] raising the percentage of our citizens who are considered to be mentally ill — they are surprised to learn that it is already an astounding 50% lifetime; [2] increasing the cost of drug treatments and their harmful side effects; [3] pulling scarce mental health resources away from those who are really ill and most need them; [4] distorting benefit determinations for insurance, disability, compensation, and school services; and [5] creating great confusion in the courts.

    The people I speak to all quickly understand the public health and public policy significance of DSM-5 and that government has a big stake in making it safe.  I am especially reaching out to the HELP [Health, Education, Labor & Pensions] committee chaired by Sen. Tom Harkin [D-IA], which oversees mental health issues and to Sen. Charles Grassley [R-IA], who has been very successful in holding doctors accountable. People in government are particularly concerned when I tell them that DSM 5 will have its worst impact on the most vulnerable populations — children, teenagers, and the elderly; veterans; and the severely mentally ill. I think the sentiment is growing that government intervention will be necessary to protect the public interest from the guild interests of the American Psychiatric Association and the economic interests of the drug companies.

    I use concrete examples to get my points across. Most alarming, that DSM-5 will increase the already shameful overuse of antipsychotic drugs in kids and thus contribute to the dangerous epidemic of childhood obesity. DSM-5 will also greatly expand the diagnosis and medication treatment of ADD and indirectly facilitate the booming illegal market in prescription stimulants. DSM-5 will turn normal grief into depression. And DSM-5 will scare people into thinking they are on the road to dementia when all they have is the normal forgetfulness of aging. The Hill staffers I talk to all seem understand the risks of DSM-5 and I hope they will soon hold hearings. There is also considerable interest in the risks of DSM 5 at the VA and at DOD, where polypharmacy has been such a big problem.

    The general public can help by calling or emailing congressional representatives to request protection from DSM-5. People should demand that DSM-5 be subjected to an outside, unbiased scientific review before accepting the controversial proposals that are getting so much negative press attention. I hope a legislative option can be forged in this battle to protect the nation’s mental health from the excesses of DSM-5. I do wonder how loudly must the public and the professional mental health community shout, "Stop!", before reason prevails. We need a government agency or elected official to take the lead in protecting the American people from the impending crisis of medicalised normality and excessive prescription drug use. The government must apply the brakes on DSM-5 before pharmacological over-kill impacts harmfully on even more people."

As I read this, I find it both sad and silly that DSM-5 has allowed things to degenerate to the point where government intervention may indeed be necessary. DSM-5 has stubbornly ignored the general consensus that many of its suggestions simply make no sense and may cause grave damage both to public health and public policy. The DSM-5 hot potato suggestions should have been dropped long ago. They certainly must be rejected now.

Adding a new diagnoses in psychiatry can be far more dangerous than approving one of the new "me-too" drugs that so often come to market. It is paradoxical and nonsensical for us to carefully vet new drugs through a fairly rigorous FDA procedure but at the same time allow new diagnoses to be introduced through a badly flawed decision-making process completely controlled by just one professional organization that has lost its credibility. The new diagnoses suggested by DSM-5 will lead to widespread misdiagnosis and inappropriate drug use — causing far more damage than could possible be wrought by any new "me-too" drug.

To date, APA has failed to provide appropriate governance. DSM-5 has proven unable to govern itself, is not governed by APA, is not responsive to the heated opposition of mental health professionals and the public, and is insensitive to being shamed repeatedly by the world press. Government intervention may turn out to be the only hope to prevent massive misdiagnosis and all its harmful, unintended consequences.

    Allen Jones
    February 26, 2012 | 1:52 PM

    Dr Frances, My hat is off to you. Godspeed.

    Bernard Carroll
    February 26, 2012 | 4:00 PM

    Allen Frances deserves kudos for the coalition of common sense that has crystallized around him. The American Psychiatric Association has forfeited trust and credibility in the DSM-5 effort. Their thuggish behavior towards Allen Frances and then Suzy Chapman was contemptible. Speaking personally, I have sent detailed, constructive materials in their direction without ever receiving a substantive response. It’s like communicating with a black hole.

    There seems to be no point in cutting the APA any more slack. I like the idea of working on HHS, Medicare, DOD, the VA and insurance companies to disallow DSM-5 for clinical and administrative use.

    February 26, 2012 | 5:48 PM

    It does seem to be coming down to that – DSM-NADA. I guess they were counting on inertia.

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