1 Boring Old Man

Psychologists Petition Against DSM-5:
Users Revolt Should Capture APA Attention
Psychiatry Times
By Allen Frances, MD
October 24, 2011

^{Several divisions of the American Psychological Association have just written an open letter highly critical of DSM-5.They are inviting mental health professionals and mental health organizations to sign a petition addressed to the DSM-5 Task Force of the American Psychiatric Association. You can read the letter and sign up at http://www.ipetitions.com/petition/dsm5/. It is an extremely detailed, thoughtful, and well written statement that deserves your attention and support. The letter summarizes the grave dangers of DSM-5 that for some time have seemed patently apparent to everyone except those who are actually working on DSM-5. The short list of the most compelling problems includes: reckless expansion of the diagnostic system…; the lack of scientific rigor and independent review; and dimensional proposals that are too impossibly complex ever to be used by clinicians.}

^{The American Psychiatric Association has no special mandate or ownership rights giving it any special sovereignty over psychiatric diagnosis. APA took on the task of preparing DSM’s 60 years ago because it then seemed so thankless that no other group was prepared or willing to do it. The DSM franchise has stayed with APA only because its products were credible enough to gain widespread acceptance. People used the manual only because it was useful. DSM-5 has strained that credibility to the breaking point and [unless radically changed] will be much more harmful than useful. We have reached a turning point that will soon become a point of no return. A near final version of DSM-5 must be ready by next spring and all final wording will be set in stone within a year. Time is running out if DSM-5 is to be saved from itself.}

^{Rescue attempts and pushback are coming from numerous directions and are fast gaining momentum. The American Psychological Association was preceded by an even harsher critique by the British Psychological Society. The Society of Biological Psychiatry has wondered why we need a DSM-5. Experts in personality disorder have universally decried the proposed revisions in DSM-5. And the American Counseling Association will soon weigh in with its own statement on DSM-5. Meanwhile DSM-5 has lived in a world that seems to be hermetically sealed. Despite the obvious impossibility of many of its proposals, it shows no ability to self-correct or learn from outside advice. The current drafts have changed almost not at all from their deeply flawed originals. The DSM-5 field trials ask the wrong questions and will make no contribution to the endgame.}

^{But the DSM-5 deafness may finally be cured by a users’ revolt. The APA budget depends heavily on the huge publishing profits that accrue from its DSM sales. APA has ignored the scientific, clinical, and public health reasons it should omit the most dangerous suggestions –  but I suspect the APA will be more sensitive to the looming risk of a boycott by users…}

Petition Against DSM-5 Gets Off To Racing Start:
A Game Changer?
Psychiatry Times
By Allen Frances, MD
October 26, 2011

^{Just a few days ago, 3 divisions of the American Psychological Association posted a well crafted open letter spelling out the many risks posed by DSM-5 and inviting mental health professionals to sign a petition requesting much needed changes. You can see the letter and [if you agree with it] sign the petition at http://www.ipetitions.com/petition/dsm5/. The posting was done in a singularly obscure way – on a weekend, with no press release, no Facebook, no Twitter– no promotion at all. Remarkably, more than a than 1000 mental health professionals signed the petition in just its first 4 days – and the numbers are  growing steadily and at an increasing rate. It is far too early to predict how many people will eventually sign on and what impact, if any, the petition will have on the APA. I have heard that the APA and the DSM-5 leadership are aware of the letter and petition, but plan no formal response. They hope to ride out the storm of opposition  mounting on all sides [detailed in a previous blog] and dismiss it as the work of professional rivals or antipsychiatry malcontents. Characteristically, DSM-5 offers no rebuttal based on evidence. Instead, it stubbornly soldiers on in its promotion of radical diagnostic changes that are risky, untested, unsupported by a strong science base, and vigorously opposed by the field.}

^{Let’s be clear. The general  opposition to DSM-5 is simply that –  opposition to DSM-5, not to psychiatry. Hiding behind the excuse that critics are impugning psychiatry because they are afraid of DSM-5 just wont cut it. Sure there are some in the anti-psychiatry crowd enjoying this sad fiasco, but they are a tiny minority and their existence should not warrant giving DSM-5 immunity from the criticism it so justly deserves.}

^{The really unexplainable paradox is the APA’s systematic promotion of greater diagnostic inflation at a time when we are already so obviously plagued by diagnostic inflation, fad diagnoses, and false epidemics. Unless it comes to its senses, DSM-5 will promote greater drug use exactly when we have a public health problem caused by the inappropriately loose prescription of antipsychotics, antidepressants, antianxiety agents, pain medicines, and stimulants. The paradox is that, contrary to conspiracy theorists, the DSM-5 experts are not making their risky suggestions because of financial conflict of interest or the desire to line drug company pockets. They have the best of intentions, but are terminally naïve about how their suggestions will be misused in actual everyday practice mostly by primary care physicians who do most of the inappropriate prescribing…}

^{But the DSM-5 deafness may finally be cured by a users’ revolt. The APA budget depends heavily on the huge publishing profits that accrue from its DSM sales. APA has ignored the scientific, clinical, and public health reasons it should omit the most dangerous suggestions – but I suspect the APA will be more sensitive to the looming risk of a boycott by users.}

^{Here are best case and worst case scenarios. Best case: APA opens up DSM-5 to external, independent review and only those suggestions that pass muster are included. DSM-5 becomes safe, usable, and widely used. Worst case: DSM-5 stumbles along blindly as it has and includes most or all of its harmful suggestions. It loses its status as a useful and standard guide to psychiatric diagnosis, creating an unnecessary and unfortunate babel of practice and research habits. And the American Psychiatric Association goes broke.}