{"id":21222,"date":"2012-03-15T23:27:52","date_gmt":"2012-03-16T04:27:52","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=21222"},"modified":"2012-03-15T23:40:13","modified_gmt":"2012-03-16T04:40:13","slug":"the-code","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/03\/15\/the-code\/","title":{"rendered":"The Code<\/font>…"},"content":{"rendered":"\n
from:<\/sup><\/div>\n
\n
DSM-5 Critics Pump Up the Volume<\/font><\/strong><\/u>
MedPage Today<\/font><\/strong>
By John Gever
February 29, 2012<\/div>\n

<\/p>\n

DSM-5 Leaders Stand Their Ground<\/font><\/strong><\/div>\n
In a conversation with MedPage Today<\/em>, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base. For starters, Kupfer said, the proposed revisions were still open to change or abandonment. The DSM-5 will assume its near-final form in June or July, he said — meaning that the APA’s annual meeting in May would provide another forum to debate the changes. "[The proposals] are still open to revision," he said. "The door is still very much open." Oldham said he was satisfied with the process so far. "It’s an enormously long, and difficult, and challenging thing to do," he said. "We’re not going to get it perfect. I don’t think anybody could. I don’t think any previous edition could."<\/p>\n

Oldham and Kupfer also argued in favor of removing the bereavement exclusion from the depression criteria. Said Kupfer, "If patients are suffering not from normal sadness or grief, but are suffering from a severity of symptoms that constitute clinical depression, and need intervention, and they want help, that they should not be prevented from getting the appropriate care that they need because somebody tells them that, well, this is what everybody has when they have a loss." Oldham noted that extreme sadness can be triggered by any number of events – natural disasters, physical disability, job losses – yet the DSM-IV created an exclusion only for "bereavement."<\/sup><\/div>\n

He also pointed out that there are "ranges of heritable risk for major depression" – suggesting that depression may in some sense be normal, yet deserving treatment nonetheless. The DSM’s overarching purpose, Oldham said, is to enable "patients who need treatment [to] get it."<\/font><\/strong><\/sup><\/p>\n

Kupfer conceded that field trials of the revised criteria, by design, were not testing whether the changes would increase or decrease the number of people receiving a particular diagnosis. As a result, the critics’ worries won’t be refuted or confirmed until after the revisions go into effect."We won’t get 100% consensus on all the proposals," Oldham said. "That would be totally unrealistic. But I personally think it’s been a thorough and careful process. We’re going to have disagreement. That’s going to happen."<\/sup><\/div>\n<\/blockquote>\n
In reading the the verbage from the DSM-5 Task Force, the APA, or KOL<\/strong>lege of KOL<\/strong>s in general, there are certain codings that need to be understood to make sense out of the peculiar things they say – usually with some passion. The quotes here have many examples of The Code<\/font><\/strong>:<\/div>\n
    \n
  • \n
    "If patients are suffering not from normal sadness or grief, but are suffering from a severity of symptoms that constitute clinical depression, and need intervention, and they want help, that they should not be prevented from getting the appropriate care that they need because somebody tells them that, well, this is what everybody has when they have a loss<\/em>."<\/div>\n
    Can anyone imagine that a person in that circumstance would be told something absurd like that in 2012? It’s a ludicrous assertion. So why would they be saying something like that? It has nothing to do with any clinical reality I can imagine. But it makes sense if you know The Code<\/font><\/strong>: Three examples here:<\/div>\n
      \n
    1. intervention<\/font><\/strong> = medication<\/font><\/strong><\/li>\n
    2. \n
      The DSM-5<\/font><\/strong> is not a Diagnostic Manual<\/font><\/strong>, it is a Treatment Manual<\/font><\/strong><\/div>\n<\/li>\n
    3. \n
      the DSM-5 Task Force thinks that their book is so important that what they say in it will determine what doctors do<\/font><\/strong>, not function as a classificatory system to help them decide what to do – so again Diagnosis<\/font><\/strong> = Treatment<\/font><\/strong> [can you say Algorithm?] <\/div>\n<\/li>\n<\/ol>\n<\/li>\n
    4. \n
      "patients who need treatment [to] get it<\/em>."<\/div>\n
       treatment<\/font><\/strong> = medication<\/font><\/strong><\/div>\n<\/li>\n
    5. \n
      "‘ranges of heritable risk for major depression’ – suggesting that depression may in some sense be normal<\/em>"<\/div>\n
      Saying that grief is not a mental illness but a part of being human – in other words a psychological experience of living – can’t be right. All mental illness has something to do with the brain. Therefore, grieving people who get depressed must have a "heritable risk for major depression.<\/em>" So in The Code<\/font><\/strong>, all mental illness is biological<\/font><\/strong>.<\/div>\n<\/li>\n
    6. \n
      "The DSM’s overarching purpose, Oldham said, is to enable ‘patients who need treatment [to] get it.’<\/em>"<\/div>\n
      I don’t have any idea where that statement comes from. I thought it was to classify mental illness. Is there some shortage of people [doctors] treating mental illnesses [treating as in medicating]? That’s news to me. I thought it was the other way around. But in The Code<\/font><\/strong>, this makes perfect sense: Diagnosis<\/font><\/strong> = Treatment<\/font><\/strong> and treatment<\/font><\/strong> = medication <\/font><\/strong>because <\/font><\/strong>all mental illness is biological<\/font><\/strong>. <\/div>\n<\/li>\n<\/ul>\n
      I wish I were just joking, making up satire, creating Straw Men, but I’m not. Try The Code<\/font><\/strong> out as you read what they say. We’ve got to catch psychosis early because Diagnosis<\/font><\/strong> = Treatment<\/font><\/strong> and treatment<\/font><\/strong> = medication <\/font><\/strong>because <\/font><\/strong>all mental illness is biological<\/font><\/strong>. Same for grief, Sleep disorders, psychosis, behavior disorders, etc. I find myself thinking that the DSM-5 Task force doesn’t need to be tweaked, but rather disbanded…<\/div>\n","protected":false},"excerpt":{"rendered":"

      from: DSM-5 Critics Pump Up the Volume MedPage Today By John Gever February 29, 2012 DSM-5 Leaders Stand Their Ground In a conversation with MedPage Today, APA President John Oldham, MD, and DSM-5 task force chairman David Kupfer, MD, defended their handling of the revision and argued that many of the criticisms were off-base. For […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-21222","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21222","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=21222"}],"version-history":[{"count":11,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21222\/revisions"}],"predecessor-version":[{"id":21233,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/21222\/revisions\/21233"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=21222"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=21222"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=21222"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}