APA President Jeffrey Lieberman
…The latest in APA’s fluffy public relations has come from the president of the American Psychiatric Association. He has made two astounding claims – that criticism of DSM-5 is somehow equivalent to criticism of psychiatry and that it signifies stigma against mental illness. Patrick Landman, a prominent French psychiatrist who has written an excellent book on DSM-5, wrote this rousing response to this new APA PR offensive:
Let’s be clear – to oppose DSM-5 is not to oppose psychiatry. Recently, the APA leadership has been portraying all opposition against DSM-5 as a form of anti-psychiatry. This is nonsense. Such rhetoric aims to discredit critics so that DSM-5 does not to have to respond to their serious and well-documented arguments. Opposition to the DSM-5 methods and changes comes from all over the world and includes tens of thousands of psychiatrists, clinical psychologists, counselors, social workers and other mental health practitioners. The people who oppose DSM-5 belong to many different schools of thought, but unite in the worry that it is not safe or scientifically sound. We are all deeply invested in psychiatry and cannot by any stretch of the imagination be seen as anti-psychiatry. Indeed, we are trying to save psychiatry from the errors of DSM-5.The stigma issue is equally a red herring. We are deeply concerned with the dignity and rights of all users of psychiatry and committed to the struggle against all forms of discrimination against the mentally ill. Most who oppose DSM-5 do not reject the classification of mental disorders. We consider it essential for epidemiology, research, and clinical work. What we do contest is the specific reliability, validity and usefulness new DSM-5 diagnoses and also the closed and disorganized way in which it was prepared.
Even those critics of DSM-5 who question its reductionistic biomedical model do not question a biological contribution to mental disorder. They are in favor of real scientific breakthroughs, but refuse to accept a purely biological ideology. They do not reject the use of medication when it is useful to bring about a patient’s remission or recovery.
Finally, saying that the DSM-5 will lead to over-diagnosis and over-medicalization of forms of behavior which for the longest time have been perceived as part of normal human variation [such as mourning] and that the DSM-5 will trigger new false epidemics and lead to inappropriate drug prescriptions which may turn out to be dangerous [especially in children] has nothing whatsoever to do with anti-psychiatry but rather accords with common sense and … yes, the defense of psychiatry.Thanks, Professor Landman. It would be wonderful to watch you debate the APA president on this question- whether opposition to DSM-5 is really pro-psychiatry or anti-psychiatry. We can safely bet who would win, but also that such debate will never happen. APA Public Relations would never approve it. So look for a continued flow of desperate APA puffery – and don’t be surprised by the lack of DSM-5 substance. It is impossible to defend the indefensible.
PLoS Medicine
by Lisa Cosgrove and Sheldon Krimsky
March 13, 2012
Summary Points
Conclusion:The DSM-5 will be published in about 14 months, enough time for the APA to institute important changes that would allow the organization to achieve its stated goal of a “… transparent process of development for the DSM, and …an unbiased, evidence-based DSM, free from any conflicts of interest” [emphasis added]. Toward that goal we believe it is essential that:
One reason to follow the non-US perspectives is that the influence of insurance carriers and the pharmaceutical industry is less a factor in their systems. Currently, much of US psychiatry is shaped by the two industries, the government, and the legal system. I think that the consensus is that unless the specialty adapts to these external forces, it can’t survive – that there’s little choice and to think otherwise is naive.
The pharma money must flow. NAMI Stakeholder Advisory Group.
http://www.nami.org/Template.cfm?Section=ACT-TA_Center&template=/ContentManagement/ContentDisplay.cfm&ContentID=51807
Alternatives to ACT:
http://www.jlaguidebook.org/jla-guidebook.asp?val=18
How ironic, I wrote a post about this issue, how the extremists of psychiatry are basically just as polarized and vision-less as the antipsychiatry lobby.
And now the APA illustrates projection and deflection as the most effective defenses of maintaining DSM 5 be accepted.
Clueless and pathetic. Hollow, if not empty debate these days. Well, we are not with you APA and DSM 5 apologists and defenders, so, we are…?
Critical of the current orthodox psychiatric paradigm?
What about allowing someone to define themselves.
I would be considered by many to be “anti-psychiatry.”
But, I think it’s much more important for a person to determine what they are *for* (not just what they are against).
Pro-freedom, pro-recovery, pro-wellness, pro-thriving.
And I’m not alone, as we enter the “Post-Psychiatry” Era.
Duane
The ‘anti-psychiatry’ label is dismissive.
It hurts a bit,.
Especially considering there are many folks out whose primary interest is to see a new paradigm of care – safe and effective treatment options…
Ones that have *never* been found in the conventional bio-pharmacological model, by the way. Not ever!
Duane
Joel,
Polarizing?
Pot, meet kettle.
Duane
Actually, I have no problem with being called “anti psychiatry” anymore than I have a problem being labelled “anti racism”. Those who have a problem with being labelled “anti psychiatry” must think that there is something noble or salvageable in what it’s called “psychiatry”. My contention is that there is nothing salvageable.
Let’s see if we can agree on the following,
1- Psychiatry does not deal with behavior caused by clear biological causes such as brain injuries, late stages of syphilis, Alzheimer’s or genetic disorders such as Down syndrome.
2- Psychiatry deals with behaviors outside the realm of 1-, it cannot offer any scientific cause for them only “DSM committee members” consensus.
Sorry, can anybody tell the difference between this and the practice that some theologians that pathologize unacceptable behavior based on their own book?
The idea that being “anti psychiatry” is equivalent to being an AIDS denialist (or oncology denialist) is preposterous. This is how AIDS denialism is falsified http://www.aidstruth.org/denialism/dead_denialists .
So I think that the real struggle is among those who realize that psychiatry is a rotten profession but still stick to it for some reason without really embracing the reality that they have been lied to for most of their lives.
This is the place where Allen Frances finds himself now. He thinks that his vision of DSM-IV psychiatry (not its practice) is a noble and salvageable enterprise even though it is as arbitrary as DSM-5 psychiatry. His team lowered the bereavement exclusion to depression from 1 year to 2 months. It is very hard to argue that that is not arbitrary but lowering it to 2 weeks is.
Allen Frances, and those who find themselves defending similar positions, would have their legacy much better assured if they joined those of us who denounce psychiatry for the scam it is. That is not to say, certainly I do not affirm that, that human suffering is not real or that people shouldn’t be helped. But we should start accepting the fact that having an MD degree is irrelevant to helping fellow human beings who suffer. And that “medicalizing” said suffering is about as abusive as the “eugeni-zation” of it.
“This is how AIDS denialism is falsified http://www.aidstruth.org/denialism/dead_denialists . ”
Just as Steve Jobs found out that being an oncology denialist is costly :D.
Lieberman has good personal reasons to kick up a cloud of dust over criticism of psychiatry.
New president of the American Psychiatric Association Jeffrey Lieberman was principal investigator in the the CAFE and CATIE studies of atypical antipsychotics criticized by Dr. Carl Elliott for ethical lapses and other problems. http://blogs.scientificamerican.com/molecules-to-medicine/2013/05/24/anti-psychiatry-prejudice-a-response-to-dr-lieberman/
Dan Markinson died in the CAFE study http://blogs.law.stanford.edu/lawandbiosciences/2012/12/14/how-not-to-run-a-drug-study-the-university-of-minnesota-puts-on-a-clinic/ .
Mickey,
You have to get this out.
Astonishing admission by Allen Frances (minute 41:20 and after; it’s from a hangout organized by Science magazine this week on the matter),
http://www.youtube.com/watch?v=Gkibj2cDeUs
To the question of what is “normal” he openly admits that the DSM definitions are not diseases but social constructs that exist in a cultural context that are relevant at the time they are written. If there was going to be an explicit admission that psychiatry is a parallel system of social control, this is it.
Antipsychiatry is applicable. Commenters call for ALL psychiatrists to be dismissed or removed from society, and at times even criticize ANY mental health service provided.
So, isn’t that ANTI the intervention?
Oh, and no, Duane, not a black kettle, I have noted legitimate criticism of psychiatry, and myself critical of the extreme elements that run APA and academia, I practice moderation in my profession and feel my blog represents this.
Frankly, I interpret your comment just to again associate me with said extreme groups simply because of the “MD” after my name. Which surprises me per a recent comment you made at my site about the “Mirror mirror” post I allude to above.
I am not going to renounce my decade plus of education and training just because of a group of old, narrow minded, greedy, self serving bastards who get away with their disingenuous at best/egomaniacal needs of the few only agenda.
I help people, and I challenge those who don’t but should.
FYI
Blog PsychPractice
Friday, May 24, 2013
WHO-Hoo!
“Here’s some good news for anyone who doesn’t want to buy, read,
or use the DSM-5.
The World Health Organizatio (WHO) provides free online ICD-10 access, and free online ICD-10 training. I worked through most of the training, and it’s a bit dull, but pretty intuitive.”
Fittingly, Mental and Behavioral Disorders are in chapter V.
“ICD-10 codes are very different from ICD-9 codes, which are structured like DSM codes. Will insurance companies accept them? Looks like they will, starting October 1, 2014. Until then, ICD-9 will have to do.”
http://psychpracticemd.blogspot.com/2013/05/who-hoo.html
fyi
an internist comments on the “lieberman response” and trends in psychiatry
Molecules to Medicine
Demystifying drug development, clinical research, medicine, and the role ethics plays
Anti-Psychiatry Prejudice? A response to Dr. Lieberman
By Judy Stone | May 24, 2013 | Comments22
Facets of the field
Kelly Hills (@rocza) was kind enough to call my attention to the guest post on SciAmMind by Jeffrey Lieberman, incoming president of the American Psychiatric Association (APA).
http://blogs.scientificamerican.com/molecules-to-medicine/2013/05/24/anti-psychiatry-prejudice-a-response-to-dr-lieberman/
FYI
Freud Museum Annual Lecture 2013: How Well Does Freud’s Work Stand the Test of Time? (Allen Frances, MD)
Freud Museum Annual Lecture 2013
The Freud Museum and King’s College London present The Freud Memorial Lecture 2013
Dr. Allen Frances: How Well Does Freud’s Work Stand the Test of Time?
5 June 2013 7.30pm (doors open at 7.15pm)
Edmond J Safra Theatre, King’s College London, The Strand, WC2R 2LS
Allen Frances, MD, was the Chair of the Task Force that prepared the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), often called the bible of the American psychiatric profession. However, he has been a vocal critic of the new DSM V, condemning what he calls its diagnostic hyperinflation. His new book, Saving Normal, is part mea culpa, part j‘accuse, and part cri de coeur. It explores why psychiatry has always been subject to so many fads, while deploring the medicalization of everyday human experience and the excessive use of psychiatric medicine.
In the prestigious Freud Memorial Lecture, Dr Frances argues that the current under-estimation of Freud is in part the price for his having been overestimated during his lifetime. ‘It is unwise to worship Freud or the DSM as bibles – but equally unwise not to know them,’ he says. His lecture will draw attention to which of Freud’s contributions he thinks still relevant, which quaint historical artefacts.
A graduate of the Columbia University Psychoanalytic Center, where he taught the Freud course for ten years, Allen Francie is now Professor Emeritus in the Department of Psychiatry and Behavioral Sciences at Duke University, where previously he was Chair.
Convenor: Lisa Appignanesi, Chair of the Freud Museum and visiting Professor in Literature and the Medical Humanities, Kings College London.
The Freud Memorial Lecture is a leading event in the Freud Museum London Events Calendar. In past years it has been delivered by such luminaries as Edward Said, Slavoj Zizek, Adam Phillips and Michael Brearley.
Advance booking recommended. Tickets are free for King’s staff and students.
http://historypsychiatry.com/2013/05/24/freud-museum-annual-lecture-2013-how-well-does-freuds-work-stand-the-test-of-time-allen-frances-md/
FYI
i dislike clogging your comments with posts but it was important to refer this one to you
Last updated: May 22, 2013 8:53 pm
US doctors paid $1bn by top drug companies
“High quality global journalism requires investment. Please share this article with others using the link below, do not cut & paste the article. See our Ts&Cs and Copyright Policy for more detail. Email ftsales.support@ft.com to buy additional rights. http://www.ft.com/cms/s/0/8eb985e0-c133-11e2-9767-00144feab7de.html#ixzz2UPjGGJbw
Different groups have analysed the data in different ways. A separate study by the consultancy ta-Scan found that doctors specialising in diseases of the central nervous system and mental disorders receive more money from the pharmaceutical industry than their counterparts in other branches of medicine. ”
http://www.ft.com/intl/cms/s/0/8eb985e0-c133-11e2-9767-00144feab7de.html#axzz2UPiHuZLL
Joel,
Again, the term “anti-psychiatry” is dismissive and marginalizing.
You’re a bright person.
You know what I’m talking about.
Duane
Joel,
I think you touched the crux of the problem here,
“I am not going to renounce my decade plus of education and training just because of a group of old, narrow minded, greedy, self serving bastards who get away with their disingenuous at best/egomaniacal needs of the few only agenda.”
If somebody like you, who is able to see how rotten your profession has become, is unwilling to call it quits because of your own personal interests, it is a complete lost hope to have those like Lieberman or Ron Pies, true believers, to embrace reform, let alone to give up.
As I said above the real struggle is among those who realize that psychiatry is a rotten profession but still stick to it for some reason without really embracing the reality that they have been lied to for most of their lives.
CannotSay,
I don’t like the term”ant-psychiatry because it’s used alongside scientology. Also, it conjures up images of folks who are against science. It creates the false assumption that we don’t care about human suffering, or helping people overcome deep emotional distress. None of these things are accurate.
And, being “anti” anything says nothing about what a person is for.
I prefer to be known for what and whom I support.
Not simply what I’m against.
Duane
Duane,
As I explained above, I have no problem with being labelled “anti psychiatry” because I honestly believe that there is nothing salvageable in what today is considered “psychiatry”, ie, the medicalization of human behavior.
That is not to say that I don’t believe that human suffering is real or that people don’t deserve to be helped. But the lie that an MD degree qualifies one to be the “best helper” or gives that same person authority to force “help” onto people is preposterous on its face. Psychiatry is not a legitimate branch of medicine.
So the cardiologists who put stents falsely in people should damn the whole specialty?
And the overprescribing of statins and antibiotics, PCPs next for the firing squad??
Face it, there are commenters who have no other agenda for all psychiatrists.
And, I find it insulting to tell me to disregard my life training because there are assholes in my profession. Disingenuous dialogue here, folks.
Joel,
“So the cardiologists who put stents falsely in people should damn the whole specialty?”
This is a false analogy. Cardiologists have a record of what Tom Insel calls “precision medicine” that psychiatry doesn’t have. What is considered a positive outcome of a cardiologist intervention can be precisely defined as well as the risks involved in any said intervention.
Again, false analogy, as “false” as claiming that so called “mental illness” is like a bodily disease.
“And the overprescribing of statins and antibiotics, PCPs next for the firing squad?? Face it, there are commenters who have no other agenda for all psychiatrists.”
I cannot comment for other commenters but I can speak for myself. I would certainly like to see the psychiatrists who abused me in Europe in jail, but that is not going to happen (per the European Court of Human Rights’ case law that has given said abuse legal coverage). What my best outcome is in the context of the current crisis is that psychiatry loses ALL of its coercive powers. I repeat ALL (not all EXCEPT in case a, b, or c). Let the criminal justice system handle cases of dangerous people. That onto itself would be an achievement. Bonus points if psychiatry were to achieve homeopathy status: a discipline that is freely practiced and in which people are free to engage, regulated by the FDA, whose services are covered by some insurers but that has ZERO credibility as a scientific discipline, thus its opinions are not given any validity in legal proceedings.
“And, I find it insulting to tell me to disregard my life training because there are assholes in my profession. Disingenuous dialogue here, folks.”
There are assholes in all fields of knowledge (Peter Duesberg, despite his NAS membership, has caused more deaths than any other scientist I can think of). Only, in psychiatry they seem to be more prevalent than in other disciplines. This point was made evident by Chuck Grassley in 2008. His 2008 investigation was not targeted at psychiatry per se, but at conflicts of interests of researchers receiving NIH money. It turned out that the majority of all conflicts of interests uncovered happened in psychiatry, including by a sitting APA chair. So!
All those deaths in somatic hospitals each year, that number pails in comparison to those hundreds of thousands psychiatrists have caused, not.
Word to the wise reading here, there are antipsychiatry AND antiphysician lobbies who cruise the net, probably those who overlap in agenda often.
People have been wronged by providers, no argument here. To demand all psychiatrists stop practicing is not a viable argument to help people with real mental illness. Go read Paul Fink’s column I posted about at my blog last week, you all want PCPs to be defacto psychiatrists?
Careful what ya wish for!
Joel,
“All those deaths in somatic hospitals each year, that number pails in comparison to those hundreds of thousands psychiatrists have caused, not.”
The problem with psychiatry here is that the damage is much more difficult to prove because of the lack or precision of its interventions. However, if you combine the well established effect that antidepressants increase the risk of suicide (some of them by several factors), and the CDC data on suicide, I think that it is not very hard to make the case that those deaths you talk about pale in comparison of the deaths caused by antidepressant medication alone. I am not even talking about Columbine/Virginia Tech/Aurora/Newtown types of deaths caused by people who either were under drugs at the time of their crimes or had been previously. Not a very hard case to make, really.
“Word to the wise reading here, there are antipsychiatry AND antiphysician lobbies who cruise the net, probably those who overlap in agenda often.”
I am not not antiphysician but I am definitely antipsychiatry. Some people (like Lieberman) compares this to being anti medicine, however to compare my criticism to AIDS denialism is an exercise of utmost intellectual dishonesty. This is how AIDS denialims is falsified http://www.aidstruth.org/denialism/dead_denialists . Just as Steve Jobs learned the hard way the costs of denying oncology :D. What are the consequences of thinking along my lines? That my body has been spared from many years of the effects of poisonous drugs (SSRIs), saving me from a potential kidney/liver transplant (both of which had been slowly destroyed by the drugs). And of course, there is a social cost (my estrangement from my ex-family) but that only speaks of the evils of psychiatry, not its virtue.
“People have been wronged by providers, no argument here. To demand all psychiatrists stop practicing is not a viable argument to help people with real mental illness. Go read Paul Fink’s column I posted about at my blog last week, you all want PCPs to be defacto psychiatrists?”
You know, 1 month ago the crisis psychiatry finds itself in now, caused by Insel, was unthinkable. Although I know it is not going to be easy, I think that the possibility of the homeopathy-zation of psychiatry is more real now than it was just 1 month ago. It has energized many of us to speak up and to right this wrong. Psychiatry should have never been accepted as a legitimate branch of medicine.
Careful what ya wish for!
I wish for honest debate, doubt we will get it from APA/Academia nor antipsychiatry rhetoric. Just like the dishonest debate from Republicans versus Democrats.
Sometimes the deeds are the words, that is what we get from this media of the net.
But, I do respect rebuttal, and hope you find hope and faith where it impacts best.
FYI. am done my commenting at this post, Happy Memorial Day.
Joel,
I think that my rebuttal has been exquisite. These are scientifically established facts,
1- Antidepressants increase the risk of suicide
2- More Americans take antidepressants now than at any other time in history
3- The CDC reported this month that the suicide rate has increased by 28% from 1999 to 2009. This is consistent with 1- and 2-. Currently 30000 Americans die every year because of suicide.
In light of this data, concluding that psychiatry has been responsible for thousands of deaths every year (a fraction of those committing suicide) is not even hard.
Happy Memorial weekend as well :D.
PS, in case you are interested, this is where I am coming from:
http://www.madinamerica.com/2013/01/ny-times-invites-readers-to-a-dialogue-on-forced-treatment/#comment-19770
…”best outcome…that psychiatry loses all coercive powers”… Hear, hear!
People still come to this field of medicine like lambs to slaughter, ignorant that their interests may have less impact on their treatments, when so many other often are dominant. Professional, academical, economical, ideological, political, private interests of important others. But the public has access to more relevant information now than earlier, as more and more survivors and patients and good helpers – doctors among them – are speaking out.
Maybe there will be a time when health specialists work collaboratively with patients, families and community- holistically – for the greater good of all, instead of the few who wield power over others, protecting vested interests.
Berit Bryn-Jensen,
Your last paragraph says it all.
Thank you!
Duane
I’ll be the hypocrite by making this comment after noting I was done above:
“I think that my rebuttal has been exquisite.”
Wow, CannotSay2013, I think you said it perfectly for illustrating my point about antispychiatry. Thank You!
Joel,
“Wow, CannotSay2013, I think you said it perfectly for illustrating my point about antispychiatry. Thank You!”
The problem is that we are past the point where saying something like this counted as a smart argument. In the post April 29th 2013 Insel regime, my refutation is exquisite in the sense that it has been adopted by many leading thinkers. Insel has made the same point many times, ie, that the overwhelming usage of prescription drugs is correlated with increase in suicide.
If, as a conservative, you watch Fox News as much as I do, you should have noticed that they have started today an attack on “The drugging of the American Soldier” that has been repeated extensively through the day. They say it’s part 1 on a 3 part series.
Psychiatry is a pseudo science . The crisis is facing today is equivalent, if more profound, that the crisis it faced in the aftermath of the Rosenhan experiment. Hopefully, this time psychiatry will be killed (in the sense I explained above) for good.
You guys! It’s Memorial Day…