He was talking about this confidentiality agreement signed by members of the DSM-5 Task Force:
| I will not, during the term of this appointment or after, divulge, furnish, or make accessible to anyone or use in any way… any Confidential Information. I understand that ‘Confidential Information’ includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group. |
That’s how the protest of the DSM-5 began. Dr. Robert Spitzer, the father of the DSM-III and DSM-IIIR had requested some information about the DSM-5 process and they essentially said that it was none of his business, evoking the confidentiality agreement. He went ballistic and began to write about their closed shop. Was it injured pride? justified outrage? Probably both. He asked Dr. Allen Frances, who had been in charge of the DSM-IV to join him in protesting but Frances declined. Later, hearing about the Psychosis Risk Syndrome, he changed his mind and became an outspoken and global critic, not just about the process, but about their work product. Failing to engage the powers within organized psychiatry, he took his campaign to the streets, or at least to other mental health disciplines impacted by this revision, with great success [DSM5 in Distress]. Today, in Philadelphia at the APA Annual Meeting, We’ll hear the results the DSM-5 Field Trials – tests of inter-rater variability in their proposed changes. We’ll likely hear that the Attenuated Psychosis Syndrome and the Mixed Anxiety Depression Disorder flunked [DSM-5 Draft Criteria Open for Public Comment]. I would expect there will be others with very low values since they’ve already written that we should lower our expectations [don’t expect too much…]. Later in the week, we’ll hear the specifics about the Disorders.
Meanwhile, protesters will be marching on the convention with greater diversity and numbers than usual – adding people protesting the current DSM-5 Task Force to the psychiatry survivor and other groups that usually gather. This tradition of protests at the APA has roughly the same timeline as the DSM-III Revolution and the two are inter-twined. It arose in the 1970s from the early Gay Pride Movement and protests against Involuntary Hospitalization and Biological Treatments:
As a veteran of the Civil Rights Movement in my youth, I used up my own protest energies early on. I believed in that cause unambiguously. Since then, I’ve almost always been cursed with ambivalence – seeing something in both sides of most polarities – feeling uncomfortable with the zealots on either side of the fence. It’s not that I don’t have opinions, I just don’t trust them. In this week’s scene in Philadelphia, in spite of opinions and preferences, I can get on either side of a few of the elements in the mix. But sometimes, I feel that old unambiguous feeling from long ago, so I snuck some pictures into my opening collage that really don’t belong there. That’s DSM-5 Chairmen Darrel Regier and David Kupfer on the left at a hearing earlier in the year. The other picture is from last October’s Chair Summit – a CME neuroscience conference lead by Department Chairs in Psychiatry and Neurology.
There is Charlie Nemeroff [until recently chair at Emory, now at Miami] – too toxic for public display but still in game. Next is Martin Keller [until recently chair at Brown], notorious PHARMA front-man of Paxil Study 329. And next to him, Alan Schatzberg [until recently chair at Stanford] – a widely discredited PHARMA guy, but still an active player. Jeffery Lieberman, APA president elect, and Schatzberg recently moderated an American Psychiatric Foundation summit with industry about how to make it easier for the Pharmaceutical Companies to introduce new CNS drugs onto the market [APF Convenes Unique Pipeline Summit]. While Regier and Kupfer are less tarnished, their ideological taint is pernicious [and they don’t seem to even know it’s there]. I threw in Tom Insel, Director of the NIMH, since he’s also in Philadelphia talking to reporters creating his own illusions:
My neurologist cannot say whether or not the two new lesions in my corpus callosum had anything to do with my one psychotic episode. Can’t say they did, can’t say they didn’t. He cannot “prove” that I have MS either because there is not a definitive test for this degenerative disease of the nervous system. It really doesn’t get more neurological than that, yet there is not a direct correlation between the effects of lesions and their locations. It surprised me, but it’s true that a neurologist can’t look at images of lesions on the spine and brain to determine that that lesion is why a person can’t lift a foot, or that lesion can account for fatigue.
Embracing the idea that neuroscience is going to explain mental illness and lead us to the promised land of effective drug therapies is just pathetic at this point. It seems that the psychiatric industry would be better served by researching the relationship between patients who benefit from a drug therapy and the effects of that drug or combination of drugs in an effort to explain what works and how to determine who is most likely to benefit from a particular drug or combination of drugs instead of broadening the categories for pathologies.
Mickey,
You said,
“”As a veteran of the Civil Rights Movement in my youth, I used up my own protest energies early on. I believed in that cause unambiguously. Since then, I’ve almost always been cursed with ambivalence – seeing something in both sides of most polarities – feeling uncomfortable with the zealots on either side of the fence.””
I am puzzled by this comment. Mind Freedom, which has had a big role in organizing the APA protest, is pro choice regarding medication and constantly urges people to be respectful in their disagreements with psychiatry. How does that equate to being a zealot?
By the way, I am not a member of Mind Freedom or any similar type organization.
No overall complaint about Mind Freedom intended. My problem comes if I’m asked to see an intensely psychotic person who is truly dangerous. In those situations, I know that I would neither be in a position to nor feel right about agreeing with choice. As aware as I am of the subjectivity of an evaluation of dangerousness and how that concept can and has been abused, I’m unable to hold a position that is absolutely “pro-choice.” I haven’t been in situations like that for years. Who would want to be there? But that doesn’t mean the situations don’t exist. Maybe my choice of words was poor, but the cases where a psychotic person was not hospitalized and/or medicated that resulted in murders or suicides aren’t rhetorical for me. They have faces…
Legally, over my time in grade, that decision has been increasingly turned back over to the courts which appropriately inserts due process – a relief to people in the situations of making that determination. But I’m not sure that it changes the point in that a person is being deprived of civil liberties based on a possibility rather than an action. I don’t really like even considering the question, because there’s no answer until the future. The original acceptance of the task of involuntary commitment by psychiatry was because judicial commitment had been so heavily abused by families “putting someone away.” In a modern world, there’s no “away” and the courts are less corrupt so it has become much more a judicial decision. The criteria became mentally ill and dangerous. Then it became mentally ill and imminently dangerous. But no matter how refined the criteria, there are still cases where the dangerousness of psychosis is quite real.
News report of APA Philadelphia protest here http://www.philly.com/philly/health/20120506_Former_patients_protest_psychiatrist_convention.html