1 Boring Old Man

Be wary of the American Psychiatric Association
FoxNews.com
By Dr. Keith Ablow
May 14, 2012

The American Psychiatric Association [from which I resigned in protest, some time ago] is at it again — making up, then retracting, new diagnoses that their committees generate and debate. It’s as if those committees have some sort of microscope trained on humanity, identifying new pathologies and yelling, “Voila! We have found another illness! Behold the mind malady on the slide!”

In this case, while preparing to publish its big seller [and huge profit center], the Diagnostic and Statistical Manual of Mental Disorders V [DSM-V] — organized psychiatry’s compendium of known psychiatric illnesses — the powers that be at the APA have decided to remove from its latest revision of the manual a few diagnoses they thought they would include: “attenuated psychosis syndrome” and “mixed anxiety depressive disorder.” They are, however, sticking with their notion of jettisoning from the DSM-V, the diagnosis of Asperger’s Syndrome, while picking up one they call, “Autism Spectrum Disorder.”

This would be really funny, if it weren’t really dangerous. The DSM-V will be used by hundreds of thousands of clinicians who may think that they are understanding their patients better, or treating them more expertly, by labeling them with one of 300 or so disorders listed in it, then matching medications to those supposedly genuine labels. But those labels aren’t driven just by science, but by political, economic and commercial forces within the American Psychiatric Association that may have nothing to do with the wellbeing of patients – or with reality.

The labels in the DSM-V [like the Diagnostic and Statistical Manuals that came before it] have really become little more than the roadmap by which psychiatrists chase both insurance reimbursement and applause from special interest groups who lobby — sometimes very effectively — for one diagnosis to be included, or another to be removed.

See, without a numbered diagnosis — such as number 312.30 Impulse-Control Disorder Not Otherwise Specified or number 307.47 Nightmare Disorder [formerly Dream Anxiety Disorder]—insurance companies won’t write a check to social workers, psychologists or psychiatrists who help people who have terrible outbursts or can’t sleep. Without a numbered diagnosis, pharmaceutical companies can’t get an FDA indication to use a particular medicine for that diagnosis. And without a numbered diagnosis, psychiatric wards can’t get paid to treat patients who hear voices or see visions or are dependent on heroin…

Counter-argument:
Changes to DSM-V bring needed improvements
FoxNews.com
By Dr. Joseph Lieberman
May 22, 2012

^{For decades, the APA has worked diligently to provide definition in the environment of mental health through the development of the Diagnostic and Statistical Manual of Mental Disorders. Since DSM-III, each edition has provided evidence-based guidance in manual form for use by clinicians and researchers to diagnose and classify mental disorders so that patients in need can be effectively evaluated and gain access to treatments.}

^{The definition of mental illnesses may at times be a matter of debate – and they should be. But the importance of mental illness and the need to recognize and diagnose it cannot be understated.  Without them, diagnostic approaches could vary widely.  The treatment of conditions would be uneven.  Payment for services would be difficult, to say the least.}

^{However, through biomedical research and enhancement of public awareness we have made great strides in the U.S. to establish a strong scientific basis for our understanding of human behavior and brain disorders that affect mental functions and bring them out of the shadows so that people can recognize symptoms and seek treatment.}

I got to wondering if Dr. Lieberman or his APA colleagues ever wonder why so many of us quit the APA. It wasn’t like a movement. We didn’t have meetings and make some decision as a group. In my case, my wife was paying bills and said, "Do you want me to pay these APA dues" and was about to explain why she was asking. But I interrupted and said something like, "No! I didn’t even know I was still a member." That was over twenty years ago. I have no idea what per cent of psychiatrists belong. I can’t think of anyone right off that I know who goes to the meetings or participates. As I think about it, it’s kind of a non-issue. I really do wonder what Drs. Lieberman, Kupfer, Regier think about that? Do they think we’re not serious about our profession? Mavericks? Disgruntled dinosaurs? I sure don’t think of myself that way.

When I read Dr. Lieberman’s response, "Without them, diagnostic approaches could vary widely.  The treatment of conditions would be uneven.  Payment for services would be difficult, to say the least." I find myself wondering why he said those particular things. It’s not that he’s necessarily wrong, though he’s not so obviously right either. It’s more a question of why he’s talking about those things at all. Diagnostic approaches do vary widely. Treatment of conditions is uneven. Payment for services is difficult. But what does that have to do with what Dr. Ablow is saying? or the nature of mental illness? or psychiatry? I’m fumbling over my words, but I know his response really strikes a discordant note. And it’s not some sick über-rebellious part of me that’s bothered. I hear it in my best part.