While I’ve quoted rather heavily from the h-madness and Wired pieces below, I have done neither full justice. If you want to know how all this got started, these are two good places to get an enlightening overview:
According to this week’s Time Magazine, the American Psychiatric Association [APA] has just recruited a new public relations spokesman who previously worked at the Department of Defense (DOD). This is an appropriate choice for an association that substitutes a fortress mentality and warrior bluster for substantive discussion. The article quotes him as saying: “Frances is a ‘dangerous’ man trying to undermine an earnest academic endeavor.” Fresh from DOD, it may be difficult for the new spokesman to leave behind combat cliches and perhaps he is not the best judge of academic endeavors. He enthusiastically extends the APA policy of shooting the messenger because it can’t argue the message. Who knows — I may have become a picture card in his deck of high value targets…
I wonder if dangerous men know they’re dangerous? Allen Frances certainly hasn’t lived the life of a dangerous man. He was Chairman of Psychiatry at Duke and was on all of the DSM Task Force equivalents before this – directing the DSM-IV efforts himself. How might he have figured out that he had been a dangerous man in training all that time? He retired at the turn of the century and stayed out of things for a decade before he really got in touch with his inner dangerous man. Maybe being a dangerous man is infectious because Robert Spitzer [his predecessor who masterminded the DSM-III] caught it first:
The scenario started simply and privately in April 2007, five years before the revised manual was scheduled for publication. Robert Spitzer, the psychiatrist who had headed the APA’s Task Force that revised the association’s third diagnostic manual in 1980 [ DSM-III], dropped a two-line request to a colleague, Darrel Regier, Vice Chair of the Task Force that is currently updating the Association’s fifth manual [DSM-5]. Would it be possible for Regier to forward to him a copy of the minutes of the Task Force’s first two meetings? Regier answered Spitzer quickly, saying summary minutes would be available to individuals like him for private use, but asking him to wait until the APA Board of Trustees formally approved the membership of the Task Force. After an interval, having received no minutes, Spitzer renewed his request. But nine months passed before Regier gave Spitzer a definitive answer in February 2008: Due to “unprecedented” circumstances, including “confidentiality in the development process,” David Kupfer, Chair of the Task Force, and Regier had decided the minutes would be available only to the Board of Trustees and the Task Force itself. However, said Regier, the APA membership would be kept aware of DSM developments at professional meetings and through reports in various psychiatric publications. But an article four months later in the Psychiatric News, the APA’s official news magazine, propelled Spitzer into public action. We are now at June 2008, fourteen months after Spitzer’s original request.
In a letter to the editor, June 11, 2008, Spitzer began: “The June 6th issue of Psychiatric News brought the good news that the DSM-V process will be ‘complex but open.’” And, he added, just a few weeks before, the outgoing president of the APA had stated that in the development of DSM-V the APA is committed to “transparency.” Then Spitzer expostulated: “I found out how transparent and open the DSM-V process was when [Regier] informed me that he would not send me a copy of the minutes of DSM-V task force meetings . . . because the Board of Trustees believed it was important to ‘maintain DSM-V confidentially.’” Spitzer then made available in his letter a paragraph from the Acceptance Form that all Task Force and Work Group members had signed stating that during their term of appointment and after, they would not “make accessible to anyone or use in any way any Confidential Information.” “Confidential Information” was defined in broad legal terms.
| 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. |
Spitzer continued: “I didn’t know whether to laugh or cry. Laugh – because there is no way Task [F]orce and Work Group members can be made to refrain from discussing the developing DSM-V with their colleagues. Cry – because” to revise a diagnostic manual in secrecy destroys the scientific process, “the very exchange of information that is prohibited by the confidentiality agreement.” Spitzer asserted that the making of DSM-III, III-R, and IV, by contrast, had been open processes where the widest exchange of information with all colleagues was encouraged. Spitzer did not stop with this letter. Once galvanized into action, he began an unrelenting campaign against the “secrecy” of the fifth DSM revision process and urging “transparency,” soon forcing the APA to defend itself…
… Spitzer hammered on certain themes and charges tirelessly in a variety of publications spread over many months. The repetition itself, rather than appearing redundant, added intensity to his challenges, which can be summarized as follows: (1) The DSM was being developed in secret because the Task Force and Working Group [specialty committees] members had had to sign confidentiality agreements. (2) Revising a diagnostic manual behind closed doors defeats the very scientific process that is supposed to ensure the best possible scientific outcome. (3) His repeated attempts, he charged, to get the DSM-V and APA leadership to explain their departure from the past policies that had been employed by the editors of DSM-III and IV, had brought forth answers that made little sense. The leadership, Spitzer would often state, maintained that the working groups and Task Force needed privacy to freely discuss and candidly exchange views with others without worry that tentative views might be made public… The APA had also argued that making minutes of meetings and conference calls would jeopardize the APA’s intellectual property rights, but it had not explained how this would happen. Finally, (4), the APA should return to the policy that the participants in the DSM process be encouraged to interact freely with their colleagues and that summaries of DSM-V meetings and conference calls be made available to interested parties. In addition to Spitzer’s concerns, other commentators began to question whether the participants in the DSM-V process had conflicts of interest because of ties to the pharmaceutical industry…
Dr. Frances tells the story of his catching the dangerous man disease in an interview for Wired in December 2010:
Inside the Battle to Define Mental Illness
Wired
By Gary Greenberg
December 27, 2010
In July 2008, Spitzer wrote a letter to Psychiatric News, an APA newsletter, complaining that the secrecy was at odds with scientific process, which “benefits from the very exchange of information that is prohibited by the confidentiality agreement.” He asked Frances to sign onto his letter, but Frances declined; a decade into his retirement from Duke University Medical School, he had mostly stayed on the sidelines since planning for the DSM-5 began in 1999, and he intended to keep it that way. “I told him I completely agreed that this was a disastrous way for DSM-5 to start, but I didn’t want to get involved at all. I wished him luck and went back to the beach.”
But that was before Frances found out about a new illness proposed for the DSM-5. In May 2009, during a party at the APA’s annual convention in San Francisco, he struck up a conversation with Will Carpenter, a psychiatrist at the University of Maryland… At the party, Frances and Carpenter began to talk about “psychosis risk syndrome,” a diagnosis that Carpenter’s group was considering for the new edition. It would apply mostly to adolescents who occasionally have jumbled thoughts, hear voices, or experience delusions. Since these kids never fully lose contact with reality, they don’t qualify for any of the existing psychotic disorders. But “throughout medicine, there’s a presumption that early identification and intervention is better than late,” Carpenter says, citing the monitoring of cholesterol as an example. If adolescents on the brink of psychosis can be treated before a full-blown psychosis develops, he adds, “it could make a huge difference in their life story.”
This new disease reminded Frances of one of his keenest regrets about the DSM-IV: its role, as he perceives it, in the epidemic of bipolar diagnoses in children over the past decade. Shortly after the book came out, doctors began to declare children bipolar even if they had never had a manic episode and were too young to have shown the pattern of mood change associated with the disease. Within a dozen years, bipolar diagnoses among children had increased 40-fold. Many of these kids were put on antipsychotic drugs, whose effects on the developing brain are poorly understood but which are known to cause obesity and diabetes. In 2007, a series of investigative reports revealed that an influential advocate for diagnosing bipolar disorder in kids, the Harvard psychiatrist Joseph Biederman, failed to disclose money he’d received from Johnson & Johnson, makers of the bipolar drug Risperdal, or risperidone. Frances believes this bipolar “fad” would not have occurred had the DSM-IV committee not rejected a move to limit the diagnosis to adults.
Frances found psychosis risk syndrome particularly troubling in light of research suggesting that only about a quarter of its sufferers would go on to develop full-blown psychoses. He worried that those numbers would not stop drug companies from seizing on the new diagnosis and sparking a new treatment fad — a danger that Frances thought Carpenter was grievously underestimating. He already regretted having remained silent when, in the 1980s, he watched the pharmaceutical industry insinuate itself into the APA’s training programs. Frances didn’t want to be “a crusader for the world,” he says. But the idea of more “kids getting unneeded antipsychotics that would make them gain 12 pounds in 12 weeks hit me in the gut. It was uniquely my job and my duty to protect them. If not me to correct it, who? I was stuck without an excuse to convince myself.” At the party, he found Bob Spitzer’s wife and asked her to tell her husband [who had been prevented from traveling due to illness] that he was going to join him in protesting the DSM-5…
I wanted to put in the piece about Robert Spitzer to show that this kind of secretive and paranoid behavior from the DSM-5 Task Force isn’t something that developed in response to all the criticism from Dr. Frances and others. It was there from the start, and is, itself,
the very reason the criticism arose in the first place. In a recent post, I talked about a paradigm shift in the DSM-5 [
to pick up the task…], moving psychiatry to fit the vision of a small group of psychiatrists. It’s obviously an agenda that they wanted to keep to themselves. Dr. Spitzer balked at their process and Dr. Frances reacted to their work product. But to me, whatever the motivations of these two men, they deserve a place alongside the other exceptional
dangerous men in history who stood up and said "No" when it desperately needed saying. In this case, it could only have happened from the inside. People like you and me could rant until we lost our voices, but for the reaction to have come from two retired insiders who had literally created the earlier DSMs provided enough kindling to start what’s turning into a welcome wildfire.
…If I am a dangerous man, it is because I am exposing DMS-5’s carelessness and thus putting at risk APA’s substantial publishing profits. During the past 3 years, I have made numerous attempts, private and public, to warn the APA leadership of the troubles that lie ahead and to implore them to regain control of what was clearly a runaway DMS-5 process. This has had no real effect other than delaying publication of DMS-5 for a year and the appointment of an oversight committee that turned out to be toothless. I am reduced now to just one means of protecting patients, families, and the larger society from the recklessness of the DMS-5 proposals—repeatedly pointing out their risks in as many forums as possible.
Anyone who has followed any of this for a while suspects that there’s a strong pharmaceutical industry influence in this DSM-5 Task Force agenda. I certainly do. That has unfortunately turned out to be true throughout this whole era no matter how strong the denial. But proof or no proof, the net inertia is towards expanding the over-use of medication even further at a time when it’s abundantly clear that the right thing to be doing is curbing that trend drastically. When Dr. Frances says, "I am reduced now to just one means of protecting patients, families, and the larger society from the recklessness of the DMS-5 proposals—repeatedly pointing out their risks in as many forums as possible," he’s not slightly kidding. This is no longer about trying to create a more useful and rational diagnostic scheme. It’s about protecting our patients from some dangerous men who are in control of our professional organization.
Pulling out this deck of cards is going to abruptly end many a strip poker game & cause some grave disappointment in the process…lol
Oldham and others resting comforatably amongst true believers this US Presidents’ Day Weekend. http://www.nvpsychiatry.org/assets/documents/2012_Conference/2012_npa_conference_brochure.pdf I was struck, not by the pharma push throughout, from full breakfast, lunch, tea and I’m sure select dinners with exhibitors i.e. pharma, but the poverty of content. One stream – a conference? Requiring this size admin committee? What a intellectual as well as ethical joke “Psychopharmacology 2012” has become. With concerned discussions about that dastardly PLoS, DSM protection, and “dangerous men” in the corridors…
Read this in The Week magazine, march 16 edition: “4 out of 5 people between the ages of 9 and 21 at least temporarily show some form of mental illness, … ‘we have to destigmatize the idea of mental disorder’ & ‘we shouldn’t be surprised that the brain has problems, just like the rest of the body’ “. Those two quotes from co-author E Jane Costello, who heads an epidemiology program at Duke U.
Really, do these people actually hear and think about what they utter in print before it gets published!? 80% of our youth has dysfunction to be labeled a psychiatric disorder? And the brain has problems as a majority in this age group.
Shame and humility, left in the trash cans outside the doors entering academia these days, eh?
Yeah. I saw an ad yesterday saying that 1 out of 6 adults suffered from mental illness, and had the “Really?” thought myself. “Help” is getting to be a very dirty word. I curse the day I submitted myself to psychiatric drugging.
Forget about the APA and lame KOLs, go to http://www.themoderatevoice.com and read how the politicians of Pennsylvania have sold out their own constituents for profits in fragging. This is beyond troubling, it is criminal to what politicians will stoop to stay in power. Read it for yourselves, sorry can’t link it directly from an iPod.
That should be fracking, but either term is f—ing the public anyway!
One psychologist spoke out about people suffering from valid fear, but for every one I’d wager that there are at least three who would gladly label anyone actually suffering from the effects of those chemicals as “mentally ill” , and anyone who was worried about the effects as “anxious” and perhaps “paranoid”.
The doctors could still take notes and keep them for the day that these laws are struck down. They can also rally together and discuss it anyway in an act of civil disobedience that could be justified by the Hippocratic oath. The State wouldn’t be able to fire all the doctors.
BTW, if a state can pass the laws on behalf of fracking, they could pass them on behalf of the pharmaceutical companies as well.
I can’ t see the Time magazine article, but it sounds like they might have straight-facedly made the APA look ridiculous — a good sign in pop media.
Dr. Purssey — I’d love to hear more about what the rank-and-file talks about in the halls. Are the rank-and-file questioning their institutions?
FYI
http://psychnews.psychiatryonline.org/newsArticle.aspx?articleid=1032954
Studying Irritability Was Frustrating—Until Now
…”Irritability is a criterion for many diagnoses: bipolar disorder, depression, oppositional defiant disorder, anxiety disorders, pervasive developmental disorders, attention-deficit/hyperactivity disorder, and conduct disorder and is an associated feature of other disorders.”…
…”“There’s a great deal of overlap, so understanding irritability can help us understand high rates of comorbidity,†said Deveney.”…
…”Current National Institute of Mental Health (NIMH) research domain criteria call for focusing on specific symptoms—like irritability—to increase understanding of the underlying neurobiology of very complex heterogeneous psychiatric disorders.”.,..
..”Children w/th impairing levels of irritability, however, frequently develop depression and anxiety later, said Deveney. Irritability also plays a pivotal role in the controversy over the diagnosis of bipolar disorder in young people and so has major diagnostic and treatment implications.”…
“…Deveney was able to recruit 19 children with severe mood dysregulation (SMD) and 23 healthy controls for her initial study. “…
I finally found a print versions. You got it right…