APA President Jeffrey Lieberman
Is Criticism of DSM-5 ‘Anti-psychiatry’?
by Allen Frances
…The latest in APA’s fluffy public relations has come from the president of the American Psychiatric Association. He has made two astounding claims – that criticism of DSM-5 is somehow equivalent to criticism of psychiatry and that it signifies stigma against mental illness. Patrick Landman, a prominent French psychiatrist who has written an excellent book on DSM-5, wrote this rousing response to this new APA PR offensive:
Let’s be clear – to oppose DSM-5 is not to oppose psychiatry. Recently, the APA leadership has been portraying all opposition against DSM-5 as a form of anti-psychiatry. This is nonsense. Such rhetoric aims to discredit critics so that DSM-5 does not to have to respond to their serious and well-documented arguments. Opposition to the DSM-5 methods and changes comes from all over the world and includes tens of thousands of psychiatrists, clinical psychologists, counselors, social workers and other mental health practitioners. The people who oppose DSM-5 belong to many different schools of thought, but unite in the worry that it is not safe or scientifically sound. We are all deeply invested in psychiatry and cannot by any stretch of the imagination be seen as anti-psychiatry. Indeed, we are trying to save psychiatry from the errors of DSM-5.
The stigma issue is equally a red herring. We are deeply concerned with the dignity and rights of all users of psychiatry and committed to the struggle against all forms of discrimination against the mentally ill. Most who oppose DSM-5 do not reject the classification of mental disorders. We consider it essential for epidemiology, research, and clinical work. What we do contest is the specific reliability, validity and usefulness new DSM-5 diagnoses and also the closed and disorganized way in which it was prepared.
Even those critics of DSM-5 who question its reductionistic biomedical model do not question a biological contribution to mental disorder. They are in favor of real scientific breakthroughs, but refuse to accept a purely biological ideology. They do not reject the use of medication when it is useful to bring about a patient’s remission or recovery.Finally, saying that the DSM-5 will lead to over-diagnosis and over-medicalization of forms of behavior which for the longest time have been perceived as part of normal human variation [such as mourning] and that the DSM-5 will trigger new false epidemics and lead to inappropriate drug prescriptions which may turn out to be dangerous [especially in children] has nothing whatsoever to do with anti-psychiatry but rather accords with common sense and … yes, the defense of psychiatry.Thanks, Professor Landman. It would be wonderful to watch you debate the APA president on this question- whether opposition to DSM-5 is really pro-psychiatry or anti-psychiatry. We can safely bet who would win, but also that such debate will never happen. APA Public Relations would never approve it. So look for a continued flow of desperate APA puffery – and don’t be surprised by the lack of DSM-5 substance. It is impossible to defend the indefensible.
A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem PersistsPLoS Medicine
by Lisa Cosgrove and Sheldon Krimsky
March 13, 2012
The American Psychiatric Association (APA) instituted a financial conflict of interest disclosure policy for the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). The new disclosure policy has not been accompanied by a reduction in the financial conflicts of interest of DSM panel members. Transparency alone cannot mitigate the potential for bias and is an insufficient solution for protecting the integrity of the revision process. Gaps in APA’s disclosure policy are identified and recommendations for more stringent safeguards are offered.
Conclusion:The DSM-5 will be published in about 14 months, enough time for the APA to institute important changes that would allow the organization to achieve its stated goal of a “… transparent process of development for the DSM, and …an unbiased, evidence-based DSM, free from any conflicts of interest” [emphasis added]. Toward that goal we believe it is essential that:
- As an eventual gold standard and because of their actual and perceived influence, all DSM task force members should be free of FCOIs.
- Individuals who have participated on pharmaceutical companies’ Speakers Bureaus should be prohibited from DSM panel membership.
- There should be a rebuttable presumption of prohibiting FCOIs among the DSM work groups. When no independent individuals with the requisite expertise are available, individuals with associations to industry could consult to the DSM panels, but they would not have decision-making authority on revisions or inclusion of new disorders.These changes would accommodate the participation of needed experts as well as provide more stringent safeguards to protect the revision process from either the reality of or the perception of undue industry influence.
One reason to follow the non-US perspectives is that the influence of insurance carriers and the pharmaceutical industry is less a factor in their systems. Currently, much of US psychiatry is shaped by the two industries, the government, and the legal system. I think that the consensus is that unless the specialty adapts to these external forces, it can’t survive – that there’s little choice and to think otherwise is naive.