The DSM-5 Task Force and its antics have dominated and embarrassed psychiatry for several years now, and like the swirling winds in Oklahoma, left a swath of destruction in its wake that will be long remembered. It has certainly been the noisiest DSM Revision effort in history, but is substantively of almost no consequence. While APA President Dr. Jeffery Lieberman calls it a "gold standard," it’s hard to see that it’s very different from the DSM-IV of 1994. The messiness of the Depression and Anxiety categories is, if anything, messier. There are some silly additions like renaming Dr. Biederman’s Bipolar Child as Disruptive Mood Dysregulation Disorder, the invention of Somatic Symptom Disorder, and other made up place holders that won’t lead to any deeper understanding of human experience or biology. So I guess the only "gold" involved that I can see is the $25 M they left along the way.
Looking over the meeting schedule and the daily bulletins, if you subtract all the DSM-5 goings-on, there wasn’t much left. A new CEO I’ve never heard of with a lot of administrative background. A lot of politically correctness – LGBT disaster studies, bullying, gun control, minorities, prevention – things that matter but not much in the way of scientific teeth. There were lots of "advances in…" and "overview of…" and less "neurobiology of…" than usual. Drs. Alan Schatzberg and John Rush were there with an update on iSPOT [without Dr. Nemeroff]. Dr. Nemeroff had only one session on aging, whoops – replaced by the incoming APA President, Dr. Paul Summergrad [right].
There was not much about this meeting that caught my attention one way or another other than following the DSM-5 launch, and even going over the schedule of sessions and symposia, it all seemed pretty bland. Maybe I’m just getting old and hard to engage, but maybe not. Maybe there just wasn’t a lot there. It felt like a wake. On the other hand, all week long I’ve had an odd non-evidenced-based feeling – one that surprised me. The feeling is, "It’s over" – something of a relief feeling. I’m going to have to cogitate on what "It" really means. First shot is that "It" is the strangle-hold that a particular group of highly placed industry-affiliated psychiatrists have had on the specialty for several decades that has finally begun to play itself out. You can all name the ones I’m talking about. Their names fill the posts of this blog [but not the APA program].
It’s a wonderful blog. Thank you. Whenever I slip up and write PSYCHIATRY, know that I’m talking about the “it” that I’m hoping you’re right about.
I had a similar feeling today. I was contacted by the UT Board of Regents and the individual who will be investigating the complaint I submitted regarding Madhukar Trivedi’s questionable conduct. My feeling was “wow, after all these years, someone at UT is finally listening.”
Well said, Wiley! But I harbour even graver doubts as to what it – psychiatry – can achieve after listening to the chattering thoughts of dr Lieberman on the radio, on the invitation of this very good blog, one of the best, wise and humane. Thank you!
Maybe the desire to build schools of thought, starting long before Kraepelin, and stairs to climb up, above the mess and the wounds of ordinary folks, is where man, men and women, go astray, always have, always will?
Embarassed is the word for the feeling I did not understand while listening to President Lieberman. I felt deeply embarrassed. First, because he sounded like a jerk. Then, embarassed and guilty for having trusted figures like him, earlier, before I learnt better, by those I love.
It is a fabulous blog.
Was only my second APA, previous one in San Francisco 4 yrs ago, and AACAP once in 2009 also.
So I don’t have much to compare with US psychiatry conference wise.
But the shift in tone in Australian psychiatry conferences has been clear over the years and similar seemed evident here in SF 2013.
A widespread scepticism of Big Pharma – evident in the packed mtg for the antidepressant efficacy debate session on final afternoon. Opinions once radical and scorned or shamed into silence now mainstream or at least widely and easily discussed. Big Pharma themselves tucked far back in the registration hall out of sight of the main gathering eating area. Perhaps many still went to the fancy exhibitions but I never found the time and wasn’t as in conferences til recently virtually corralled into conversing with sales reps.
Scepticism too re DSM.
Our symposium critiquing Pediatric Bipolar and neglect of attachment and developmental trauma, over medicating etc. drew 70 compared with 250 four years ago. Less tension more acceptance. More a feeling of “it’s over”.
What hasn’t really started however is “what now” in my opinion. There is this call to biomarkers and a continued but maybe more nuanced drive down biological psychiatry’s mindless road. But I hope things like the Critical Psychiatry Network can arise out of this crisis/power vacuum and bring us back on a path to a truly mindful psychiatry where biomarkers and treatments are sought and used knowing that brains are for holding minds and minds are for relating with and influences are multidirectional. A sophisticated biopsychosocial model. Insel’s comments from NIMH don’t give much hope on the surface but time shall tell.
Off to Boston to a traumatology conference next week where a better future paradigm I believe is already here.
It’s the best blog
Duane
Thought some of you might find this article interesting
http://www.propublica.org/article/part-d-prescriber-checkup-mainbar
The dangerous and contraindicated use of psychiatric drugs is a monster with many tentacles. The failure to police it is structural. It seems that the APA should want to police itself rather than to allow so many psychiatrists to be associated with harm and fraud.
For those of us with a dynamic bent.
http://www.aeonmagazine.com/being-human/jay-watts-freudian-slips/