1 Boring Old Man

It’s time for the grown-ups to intervene. In this case, the grown-ups would be the Trustees of the American Psychiatric Association. I don’t know of a precedent for that, but there’s no time like the present to start such a tradition. It’s up to the Trustees to ratify the enterprise and give the go-ahead to move towards publishing the manual. Frankly, it’s not just people outside psychiatry that need for the Trustees to act definitively and get this show back onto a rational path – other mental health professionals and patients. It’s psychiatrists too. We need to see that. Right now, the APA represents a subset of psychiatrists – a dwindling minority. The APA is creating a psychiatry for biological researchers and KOLs, not practitioners. If they continue along their current path, either they will destroy clinical psychiatry as a practice, or they will produce an APA that dissolves into irrelevancy. I hate to be an alarmist, but the Trustees have more than the DSM-5 on their plate. They have the vitality of the specialty in their hands right now.

Dr. Frances assures us that the DSM-5 effort is not pharma contaminated. And while I’d like to believe him, the Task Force’s conflict of interest profiles don’t look very good to me. And some of those quirky diagnostic categories they’ve played with don’t help. From any rational perspective, this is a time for organized psychiatry to demonstrate self regulation and pay attention to the widespread misadventures of some of our most highly placed people. It was time for the Task Force to "out-Spitzer" Robert Spitzer in terms of sticking to a reliable, evidence based, atheoretical diagnostic system instead of dreaming of the future. I can think of a lot of areas where the DSM-IV could be revised in a helpful ways – cleaned up, jettisoning some of its anachronistic baggage. But this group ignored that task and went for dreams of the future. So now they’ve made a real mess of things, and are unlikely to acknowledge what a big mess it is or do anything about it. That means it falls on this group, the Trustees, and this is no time to just go with the flow. It’s time to bring things to an abrupt halt, and think very carefully about how to proceed.

^{President 2012 – 2013 Dilip V. Jeste, M.D.
President-Elect 2012 – 2013 Jeffrey Alan Lieberman, M.D.
Secretary 2010 – 2013 Roger Peele, M.D.
Treasurer 2010 – 2014 David Fassler, M.D.
Immediate Past President 2012 – 2015 John M. Oldham, M.D.
Past President 2011 – 2014 Carol Ann Bernstein, M.D.
Past President 2010 – 2013 Alan F. Schatzberg, M.D.
ECP Trustee-at-Large 2012 – 2015 Molly K. McVoy, M.D.
Area 1 Trustee 2012 – 2015 Jeffrey Geller, M.D., M.P.H.
Area 2 Trustee 2008 – 2014 James Edward Nininger, M.D.
Area 3 Trustee 2010 – 2013 Brian Crowley, M.D.
Area 4 Trustee 2012 – 2015 Judith F. Kashtan, M.D.
Area 5 Trustee 2011 – 2014 James Allen Greene, M.D.
Area 6 Trustee 2010 – 2013 Marc David Graff, M.D.
Area 7 Trustee 2012 – 2015 Jeffrey Akaka, M.D.
Speaker of the Assembly 2012 – 2013 R. Scott Benson, M.D.
Speaker-Elect of the Assembly 2012 – 2013 Melinda Young, M.D.
Member-in-Training Trustee 2012 – 2013 Alik S. Widge, M.D., Ph.D.
Member-in-Training Trustee-Elect 2012 – 2013 Erik R. Vanderlip, M.D.
APA/Diversity Leadership Fellow 2012 – 2013 Mardoche Sidor, M.D.
APA Public Psychiatry Fellow 2011 – 2013 Brian Hurley, M.D.
APA/Leadership Fellow 2012 – 2013 Lama Bazzi, M.D.
APA Medical Director & CEO James Henry Scully Jr, M.D.}