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Posted on Tuesday 26 June 2012

DSM 5 Continues to Ignore Criticism From Petitioners
Huffington Post
by Allen Frances

The petition to reform DSM 5 speaks with the powerful voice of more than 50 mental-health associations. Perhaps more important to APA’s publishing ambitions and budgetary needs, it represents a significant percentage of the potential customers who eventually will have to decide whether or not DSM 5 is worth buying and using. Displaying its usual "the customer is always wrong" arrogance, APA has previously been dismissive of the completely reasonable recommendation that there be an independent scientific review of all controversial DSM 5 suggestions. Here is an excerpt of the petition’s most recent letter to the APA and DSM 5 leadership by the authors of the petition [the full text of the letter is available here]…

DSM 5 is taking the foolhardy step of alienating its users. Its responses to critics are framed in public-relations jargon convincing to no one outside its own inner circle. Instead of PR, we need straight answers to four questions:

  1. How can you rush a DSM 5 to print with such low reliability?
  2. Why don’t you delay publication to allow time for the quality-control step that was part of your own original plan?
  3. Was quality control  cancelled for reasons other than your pressing need for quick DSM profits to meet budget projections?
  4. Why not agree to an independent scientific review of all controversial proposals to salvage the badly tarnished credibility of DSM 5?
APA’s high-priced public-relations geniuses never address these questions, because not even the cleverest "image consultants" can turn this sow’s ear into a silk purse.
I left out the letter, but it’s well worth the read. It’s very clear and precise. But I included all of Dr. Frances’ words to say that he’s finally getting mad. All along the way, he’s gone out of the way to give the DSM-5 Task Force the benefit of the doubt. They have certainly not earned it. Now, he uses words like "arrogance," "dismissive," "alienating," and "foolhardy" – all of which apply. He continues…
My Debate With The DSM 5 Chair
Psychology Today: DSM5 in Distress
by Allen Frances, M.D.
June 25, 2012

… I think ‘Newspeak’ is the best way to characterize the APA defense of DSM-5. For those who haven’t read George Orwell’s ‘1984’ lately, ‘Newspeak’ was his term for the kind of bureaucratic upside-down language that attempts to turn night into day. The idea is that if you say something enough times, the repetition will magically make it so. Let’s do a quick back-translation from APA ‘newspeak’ to DSM 5 reality.

  • APA Newspeak: DSM 5 has been open and "transparent to an unprecedented degree."
    1. DSM 5 Reality: APA forced work group members to sign confidentiality agreements; has kept its ‘scientific’ review committee report secret; tries to censor the internet using bullying threats of trademark litigation; keeps secret the content of public input; and has not, as promised, provided more complete data sets from its failed field testing.
  • APA Newspeak: DSM 5 has been an "inclusive" process.
    1. DSM 5 Reality: APA has rejected the input of 51 mental health associations requesting an open and independent scientific review of the controversial DSM 5 proposals; has not responded to highly critical editorials in the Lancet, New England Journal, New York Times, and many other publications; has ignored the unanimous opposition by the leading researchers in the field to its unusable personality disorder section; has ignored the opposition of sexual disorder researchers and forensic experts to its forensically dangerous paraphilia section; has brushed off outrage by consumer groups representing the bereaved and the autistic; has not made any changes in DSM 5 that can be associated with outside input- professional or public; and is unresponsive even to its own APA members, dozens of whom have told me they can’t get a straight (or any) answers from a staff whose salaries come from their dues.
  • APA Newspeak: "The stakes are far reaching: the first full revision since 1994 of the DSM, a document that influences the lives of millions of people around the world."
    1. DSM 5 Reality: APA quietly cancelled its own planned Stage 2 of field testing. Stage 2 was to provide quality control with much needed editing and retesting to demonstrate improved reliability. Canceling quality control was a crucial mistake and was done for one reason only-money. Because Stage 1 of the field trial was completed 18 months late, DSM 5 was running out of time in meeting its arbitrarily imposed publishing deadline. Given the choice of striving for quality or cashing in on publishing profits, APA went for the cash. Definitely dispiriting, but not surprising. APA is in deficit, has a budget that is totally dependent on the huge publishing profits from its DSM monopoly; and has wasted an absolutely remarkable $25 million in producing DSM 5 (DSM IV cost only one fifth as much). The simple reality is that APA is rushing a poor quality and unreliable DSM 5 to press purely for financial reasons and totally heedless of the detrimental effect this will have on "the lives of millions of people around the world.
  • APA Newspeak: "Charges that DSM-5 will lower diagnostic thresholds and lead to a higher prevalence of mental disorders are patently wrong. Results from our field trials, secondary data analyses, and other studies indicate that there will be essentially no change in the overall rates of disorders once DSM-5 is in use."
    1. DSM 5 Reality: DSM 5 made a fatal and unaccountable error in its field testing – it failed to measure the impact of any of its changes on rates and APA therefore has no meaningful data on this most important question. With the exception of autism, all of the suggested DSM 5 changes will definitely raise rates, some dramatically. Adding Binge Eating Disorder by itself would add more than ten million new ‘patients’; adding Disruptive Mood Dysregulation Disorder and Minor Neurocognitive Disorder would add millions; as would removing the bereavement exclusion to MDD and lowering thresholds for ADHD and GAD.

Read the full Medscape exchange for more Newspeak from Dr Kupfer, but you get the idea. It is not at all clear to me if APA talks Newspeak cynically, because of naivete, or because Newspeak is the language its expensive public relations consultants put in its mouth. It doesn’t really matter why. Newspeak is devastating – not because anyone outside DSM 5 believes it [DSM 5 defenses are too transparently out of touch with reality to fool outsiders], but because APA may believe its own Newspeak or at least acts as if it does. Reflexive Newspeak, substituting for insight, has prevented DSM 5 from the serious self correction that would have saved it from itself. Bob Spitzer presciently predicted five years ago that a secretive, closed, defensive DSM 5 process would lead inevitably to this failed DSM 5 product.
I think Dr. Frances must have reached the same conclusion I did in the Salt Marsh last week, though he expresses it more eloquently [a thought…] – the DSM-5 spokesmen are not engaging this debate genuinely. They are "blowing smoke." Whether their motive is APA Finances as Dr. Frances believes or the anachronistic ideological agenda that I suspect, refreshing their smokescreen over and over is fooling no-one. They would do well to get a consultation from someone other than their cheesy PR firm…
    Joel Hassman, MD
    June 26, 2012 | 12:09 PM

    Like I said earlier, it is not about what is right, responsible, and appropriate perserverance when it comes to profit motivated organizations like the APA, only what is easy and convenient. The only avenue I see that will impact on this process is to do whatever is fair and respectable to shame any and all members of the APA to leave the organization so they who remain will be such a pitifully small percentage of practicing psychiatrists that the APA’s actions are meaningless and irrelevant.

    Frankly, the DSM as it stands now is nearly meaningless and irrelevant. All it is used for is coding to get reimbursement for insurance payments. Really, has any practicing psychiatrist picked up the DSM 4TR and READ the thing for interest or educational use in the past few years? I haven’t, and if that is an indictment of failure on my part, then call me on it. I seem to be up to date on identifying illnesses and pursuing provisional diagnoses to get results in patient care improvement more than less, so, I must be doing something right in the end.

    IF this is a crisis, then what do people do in a crisis? Identify the problem, apply theories/hypotheses on how to rectify it, and then put the actions into play. Deeds not words. Good luck, colleagues!

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