To ease the heartache of her first child’s stillbirth, Kelli Montgomery chose rigorous exercise, yoga and meditation over the antidepressants and sleeping pills that her physicians immediately suggested. "’You need to be on this medication or that medication.’ It was shocking to me that that was the first line of defense," said Montgomery, 42, director of the MISS Foundation for Grieving Families in Austin, Texas. "From the time I was in the hospital to when I was seeing my general practitioner, that’s what they were insisting on." Her choice stemmed partly from a longtime aversion to taking prescription drugs. It was also the result of listening to a growing group of psychiatrists, psychologists and clinical social workers from around the world who argue that depression and other normal responses to life’s toughest challenges are too often labeled as disorders — and as such, demand medicine with sometimes dangerous side effects…
Protesters such as Montgomery contend diagnoses of serious psychological and psychiatric disorders have also needlessly skyrocketed alongside the Diagnostic and Statistical Manual of Mental Disorders’ expanding list of what constitutes mental illness. The manual is considered the bible of psychiatry because it’s the criteria mental health professionals use to diagnose patients.
One example of the issue is the frequency of bipolar disorder in children. It has jumped 40-fold in the last two decades, said Dr. Bernard Carroll, a former Duke University psychiatry department chairman. "You’ve got all these young kids running around with this diagnosis, yet many of them have never, ever had a manic episode, which is the hallmark of bipolar disorder," said Carroll, now the scientific director of the Pacific Behavioral Research Foundation. "Many of these kids," he continued, "have never had anything other than irritability. Yet they’re exposed to anti-convulsants, anti-psychotic drugs, which have serious long-term side effects in the form of obesity, metabolic syndrome, diabetes and some movement disorders … that can leave a person extremely disfigured physically"…
The International DSM-5 Response Committee – named after the upcoming fifth incarnation of that diagnostic manual – plans to launch a campaign next month aimed at blocking the manual’s May 20 release. Short of that, critics plan to press ahead with their case that the DSM-5 should be viewed with some skepticism and not wholly embraced by practitioners or patients. "We believe that there is now overwhelming evidence that DSM-5 is scientifically unsound (and) statistically unreliable," said clinical psychologist Peter Kinderman, director of the University of Liverpool’s Institute of Psychology, Health and Society. He is helping organize the international campaign with petition drives in the United States, the United Kingdom and France…
However, critics contend, the manual’s shortcomings include its lack of scientifically conclusive field testing of some of its recommendations; its failure to consider the prior effectiveness or ineffectiveness of anti-psychotic drugs to determine a patient’s present diagnosis, and its lumping of, for example, what had been a spectrum of depressions — from the mildly melancholic to the severely debilitating — into one group. "This is the reason that people nowadays are jumping up and saying, ‘The antidepressant drugs don’t work,’" Carroll said. "If you take this broad category, it’s difficult to even show why they don’t work."
"There’s a great deal of a concern, so we are hardly voices in the wilderness," said Dr. Allen Frances, author of the book "Saving Normal: An Insider’s Revolt Against Out of Control Psychiatric Diagnosis, DSM-5, Big Pharma and the Medicalization of Ordinary Life." He is largely credited with spearheading anti-DMS-5 efforts. "A petition regarding DSM-5, signed by 50-plus associations, was presented to the (psychiatric association), asking for an independent scientific review. The association brushed it aside," said Frances, a Duke professor emeritus and former psychiatric department chairman…
Frances contends that the process, though conducted with volunteers, has been somewhat secretive and did not sufficiently consider objections to what the manual will contain. Frances led the task force that produced the DSM IV in 2000. "What motivates me is the experience of having inadvertently contributed to fads and psycho-diagnosis that have resulted in over-diagnosis and over-treatment," Frances said. "Some of this happened during DSM IV, even though we were more conservative with that document than they’ve been with DSM-5, with its many changes that are unsupported and, in some cases, quite reckless."
For example, Frances said DSM-5 would mislabel one in four people with chronic pain and irritable bowel syndrome with the DSM-5’s newly created "somatic symptom disorder," which is diagnosed when a person has spent at least six months steadily thinking of and being anxious about their medical illness. According to Frances and other like-minded critics, a confluence of related factors resulted in an "over-medicalizing" and over-diagnosis of mental illness. Chief among them, they contend, is that an increasing number of primary care and other nonpsychiatric doctors are dispensing anti-psychotic drugs, despite their lack of training in that area of medicine. Aggressive sales and marketing by pharmaceutical companies may also be driving the surge…
"The DSM-5, in many ways, reflects the politics of psychiatry these days," said Dr. Joel Paris, author of "Prescriptions for the Mind: A Critical View of Contemporary Psychiatry," a psychiatry professor at McGill University and researcher at Mortimer B. Davis-Jewish General Hospital in Montreal, Quebec. "Everybody has a kind of investment in certain diagnoses. Those who are studying a particular disorder often are saying, ‘Well, this is much more common than you think they are. Oh, the prevalence is very high.’ But we risk losing legitimacy because of over-diagnosis. … The fact is that most people get by with bad patches in their lives. They recover."
I’ve found CNN’s online mental health reporting to be surprisingly good; their articles seem more detailed, better-researched, and less sensationalistic than what I’ve read from the NYTimes.
FYI
Saturday, March 16, 2013
fairly granular description of proposed Brain Acitivity Map Project which proposes to
to map the activity of every neuron in the brain, and correlate the data with behavior and disease states
http://psychologyofmedicine.blogspot.com/2013/03/proposed-brain-activity-map-seeks-to.html
http://www.alzforum.org/new/detail.asp?id=3414
Proposed Brain Activity Map Seeks to Crack Neuronal Code – AlzForum Alzheimer Research News
Sorry, but in my opinion, sometimes you have to fight fire with fire.
We have seen the APA smear campaign at its lowest, it is time for people of substance and influence who see the DSM 5 for what it is not worth, and smear a little back. These leaders of the APA, they have no soul, no shame, no integrity of doing the right thing.
So, tell the public what is behind this latest assault on them.
Directly, candidly, and, to me, brutally.
Remember, you cannot negotiate with narcissism and antisocial traits.
Or, just continue to be nice and respectful. Good luck with that!
Coverage the issue of bio-psychiatry deserves must take into account its ugly racists roots and crimes against humanity, as revealed in the many criminal deeds and authoritative words. One example: The discussion in The Journal of American Psychiatry in the years 1941/42 about euthanasia, summarized the debate in favour of killing, in the July 1942 issue page 143, thus:
” If euthanasia is to become, in some distant day an available procedure, enabling legislation will be required.”
Source: The film program at the Russel Tribunal 2001 in Berlin on psychiatry at http://www.freedom-of-thought.de
I was delighted to find this blog a few months ago and now find that I check it first thing every morning to see what new treats await. I have been particularly moved by the posts that combine personal reflections from the blogger’s past career with commentary on current concerns in psychiatry (especially the Irony I, II and III posts recently).
I was trained as a clinical psychologist in the early 1980s in NYC, then spent my intrnship and first four years of clinical practice in a state hospital during the transition period to DSM-III. My clinical training was thoroughly psychoanalytic and, like an ambitious young clinician-to-be, I spent most of my meager disposable income on my own personal analyses. We had exactly one lecture on schizophrenia during my 5 years of course work in grad school. Reference was made to genetics, of course, but the emphasis was on Freud, Bateson’s “double-bind,” and Theodore Lidz’s work. The last word on schizophrenia was, we were told, Silvano Arieti’s book, Interpretation of Schizophrenia. That was it. Not much preparation, I’m afraid, for inpatient work.
As interns and new staff psychologists we consulted the algorithimic skeletons in DSM-III and tried to match them to the patients we saw. Over time it was clear that the classic Kraepelinian subtypes were fundamentally useless, so most persons with schizophrenia were marked as “undifferentiated” types. As for understanding the disorders we were seeing, Arieti, Bateson and Lidz were no help, so we passed around an old 1950 copy of the translation of Bleuler’s 1911 monograph on the schizophrenias. At least there were descriptions in Bleuler that matched what we were seeing, but still no understanding. What finally helped was E. Fuller Torrey’s 1985 edition of Surviving Schizophrenia, which made everthing much clearer.
The older staff offered inservice training once a month, primarily for the interns. All had been trained, of course, in the psychoanalytic era. Many shared their own insights from their own psychoanalysis experiences, including a psychologist in her 60s who repeatedly recounted to us the details of her emergence from her mother’s birth canal, recovered memories which were essential, she stressed, to understanding the regressed schizophrenics we were seeing. Another presented an inservice on the administration, scoring and interpretaion of the Szondi test. The hospital had many copies of this test (I snagged one of them and still have this wonderful souvenir) and encouraged us to use them and integrate the results along with the Rorschach findings in our psychological testing reports. It does seem, as this blog illustrates, a very different world just a short time ago.
The usual master narrative is that the DSM-III framers, biological psychiatry and (by the 1990s) Big Pharma drove the stake into Freud’s heart — and indeed this is largely true. But from the perspective of a “scientist-practitioner” psychologist at that time, the experimental research in cognitive psychology, particularly with respect to human memory, made such a significant counter-argument to the psychoanalytic view of how the mind works that there was really no logical reason to hold onto Freud. Also, from the perspective of that long-ago transitional period in the history of psychiatry, the everyday silliness and odd jargon of psychoanalytically-oriented coleagues made it all easy to run away from, The new DSM-speak and biobabble seemed a reasonable alternative. Over time, clinical communication on the job did improve with DSM (no more “latent schizophrenics” lurking about, for example). And — just to say something a little nice about DSM-5 — the adjustments to the criteria for schizophrenia (including dropping the historical subtypes) finally matches the reality of inpatient treatment.
Unlike the author of this blog, I was perhaps like most clinicians — working in non-elite settings and trying to sort out what I needed to learn about my new profession. Not easy during a time of transition. We had to trust the new claims of the elite experts. There were no alternatives.
I would never go back to an era in which the Szondi Test was required in clinical training and practice, but — man, oh man — I do miss the colorful chaos of those times.
1BOM,
Dr. Noll’s (evidently not a huge fan of some aspects of Dr.Jung) post got me thinking:
http://www.timeshighereducation.co.uk/news/folk-fictions/91570.article
http://www.nytimes.com/1995/06/03/us/scholar-who-says-jung-lied-is-at-war-with-descendants.html
http://www.nytimes.com/2013/02/20/books/flaws-found-in-fredric-werthams-comic-book-studies.html
Is there a parallel to the concept of the benefits of reexamining the raw data being discussed for clinical trials?
What would happen if there was more of an effort to go back to the early raw notes?
1BOM,
Would there be a benefit to a tiny parallel movement within the psychoanalytic community?
The movement from dogma to dogma, from one set of babble to another, was unfortunate. The DSM-III marked a movement away from the more nuanced, more complicated, less dogmatic work and approach of Dr. Carroll and his ilk (e.g., in the set up of the MDD category), as much as it did a movement away from psychoanalytic thought. That was even more unfortunate. The last 30 years have driven a stake through the heart of some really good biologic work as much as it has done so to psychoanalysis. Between the handling of the DSMs, the over-selling of neuroscience, the remaining analytic dogmatists, the anti-psychiatry advocates, the current financial realities, …etc, the promise of some great early psychopharmacology work has remained unfulfilled. It’s a shame. Don’t always agree with all of Dr. Carroll’s arguments, but have great respect for his long-term commitment to advocating for a research culture that promotes scientific and clinical integrity. It’s the damage done to that beneficial research culture by these decade long DSM cycles that can be easy to forget. The problem is not so much whether something is psychoanalytic babble or psychopharm babble or neuroscience babble, or anti-psychiatry babble. It’s whether or not it’s babble.
I think the first thing that needs to be done is to reign them in legally. Psychiatry has the power to drug infants, force outpatient drugging, has power in law enforcement and the courts. And it’s clearly been given the power to police itself, which has ended badly. That’s a lot of power for a profession that has so little evidence to back up its primary paradigm.
The DSM-5 needs to be declared snake-oil.
The bogus and fraudulent studies defining treatment are in desperate need of action. The FDA needs to take that on, and the American Medical Association. Psychiatrists are doctors and need to be held at least to the same standards that medical doctors are. If a medical doctor killed patients by using chemotherapy to treat a boil, they’d lose their license, if they could actually do that in the system they work in.
The obvious attempt at the top to medicate anyone who says they have a problem, or anyone whom someone else says they have a problem is clearly marketing and sales, not medicine. This is a legal and a medical abomination, and an abuse of power.
First though, I’d like to see any group with power over psychiatry (Congress if need be) to stop the drugging of infants and toddlers— it’s a crime against humanity and should be punished as such.
WHO is currently asking for eligible mental health professionals to participate in the WHO Global Clinical Practice Network and online field trials ahead of the
ICD-11. Project coordinator: Spencer C Evans evanss@who.int
Still, no reason to expect a revolutionary, new ICD. The medical vocabulary, the medical thinking is constricting, reductionistic, set to uphold status quo benefitting the most powerful professions. Revolutions do not come from the highest echelons of power.
@Wiley
I agree completely. As far as I could find, the DSM-5 will include, just as the DSM-4 included, a section on mental illness in Infants.
I came across another proposed disorder, “REACTIVE ATTACHMENT DISORDER: A REVIEW FOR DSM-5”
http://www.dsm5.org/Proposed%20Revision%20Attachments/APA%20DSM-5%20Reactive%20Attachment%20Disorder%20Review.pdf
The NPR had a story on ‘Thousands of infants on psychotropic medications” a few years ago:
http://www.npr.org/blogs/health/2011/12/01/143017520/foster-kids-even-infants-more-likely-to-be-given-psychotropic-drugs
Of all the worst things psychiatry in America has ever done, creating mental illness for babies before their nervous system has developed to a point they can even talk, and drugging them as an ‘intervention’ is quite possibly the worst crime in the APA’s history. I dread what will happen when this new manual comes out.
I sincerely hope “The International DSM-5 Response Committee” gets is presence know to the public, as far as i can tell, they do not even have a website yet. All i could find was their ‘statement of concern’.
http://www.aipass.org/files/Statement_of_concern_IDRC.pdf
“Of all the worst things psychiatry in America has ever done, creating mental illness for babies before their nervous system has developed…”
I couldn’t agree more. But, I think parents and teachers are the ones to blame. I grew up in the 90’s where I and several of my friends were diagnosed with ADD at very young ages. I accepted the fact that I had ADD until age 16.
I believe that I had some reviews from teachers that I was hyper – at age 7. My parents took me a to a psychiatrist for a solution to my problem. The psych obviously had to diagnose the problem, f.e. mental illness, in native terms that he could solve. I wonder if it ever crossed my parents minds that there was no issue, at all.
Interesting article. Thanks.
Well, Spook, Attachment Theory is actually a theory, and it has been around for quite awhile. Dealing with the problem of no or poor attachment with drug is just wrong, though. An infant that hasn’t attached needs a reliable, responsive, and empathetic caregiver to teach the infant trust and human relatedness by being trustworthy and attuned to the child’s needs.
I think most sociopaths are people who never bonded. No one wants to call a child a “sociopath” but Bundy and Damer probably didn’t have a conscience that they lost when they turned 18.
I fear that infants and toddlers that need a reliable caregiver are being drugged into silence instead of being comforted and loved by someone with the capacity to help them develop the architecture that most of us take for granted from having had good enough parenting (that we don’t remember) in our formative years which ,makes us bonded to the human race and capable of feeling trust and comfort. Too often, we give ourselves credit for what made us who we are before we formed memories of our experience.
It looks like a few are trying to keep the world safe *for* psychiatry.
Is there anyone out there trying to keep us safe *from* psychiatry?
Or is it everyone for themselves – to sort through the power and fraud – in the hope of finding an *ounce* of science, a *grain* of truth?
What a mess.
Duane