{"id":22925,"date":"2012-05-05T18:00:18","date_gmt":"2012-05-05T22:00:18","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=22925"},"modified":"2012-05-05T22:22:36","modified_gmt":"2012-05-06T02:22:36","slug":"not-a-good-time","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/05\/05\/not-a-good-time\/","title":{"rendered":"not a good time…"},"content":{"rendered":"\n

<\/p>\n

"I didn’t know whether to laugh or cry. Laugh — because there is no way task force and work group members can be made to refrain from discussing the developing <\/em>DSM-V with their colleagues. Cry — because this unprecedented attempt to revise <\/em>DSM in secrecy indicates a failure to understand that revising a diagnostic manual — as a scientific process — benefits from the very exchange of information that is prohibited by the confidentiality agreement. Such exchange of information with colleagues was encouraged with the development of <\/em>DSM-III, DSM-III-R, and <\/em>DSM-IV."<\/em><\/sup> <\/div>\n
Robert Spitzer July 18, 2008<\/sup><\/div>\n

He was talking about this confidentiality agreement signed by members of the DSM-5 Task Force:<\/p>\n\n\n
I will not, during the term of this appointment or after, divulge, furnish, or make accessible to anyone or use in any way… any Confidential Information. I understand that ‘Confidential Information’ includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group.<\/sup><\/td>\n<\/tr>\n<\/table>\n

That’s how the protest of the DSM-5 began. Dr. Robert Spitzer, the father of the DSM-III and DSM-IIIR had requested some information about the DSM-5 process and they essentially said that it was none of his business, evoking the confidentiality agreement. He went ballistic and began to write about their closed shop. Was it injured pride? justified outrage? Probably both. He asked Dr. Allen Frances, who had been in charge of the DSM-IV to join him in protesting but Frances declined. Later, hearing about the Psychosis Risk Syndrome, he changed his mind and became  an outspoken and global critic, not just about the process, but about their work product. Failing to engage the powers within organized psychiatry, he took his campaign to the streets, or at least to other mental health disciplines impacted by this revision, with great success [DSM5 in Distress<\/font><\/a><\/strong><\/u>]. Today, in Philadelphia at the APA Annual Meeting, We’ll hear the results the DSM-5 Field Trials – tests of inter-rater variability in their proposed changes. We’ll likely hear that the Attenuated Psychosis Syndrome and the Mixed Anxiety Depression Disorder flunked [DSM-5 Draft Criteria Open for Public Comment<\/font><\/strong><\/u><\/a>]. I would expect there will be others with very low values since they’ve already written that we should lower our expectations [don’t expect too much…<\/font><\/a><\/strong><\/u>]. Later in the week, we’ll hear the specifics about the Disorders.<\/p>\n

Meanwhile, protesters will be marching on the convention with greater diversity and numbers than usual – adding people protesting the current DSM-5 Task Force to the psychiatry survivor and other groups that usually gather. This tradition of protests at the APA has roughly the same timeline as the DSM-III<\/em> Revolution<\/em> and the two are inter-twined. It arose in the 1970s from the early Gay Pride Movement and protests against Involuntary Hospitalization and Biological Treatments:<\/p>\n

<\/p>\n

As a veteran of the Civil Rights Movement in my youth, I used up my own protest energies early on. I believed in that cause unambiguously. Since then, I’ve almost always been cursed with ambivalence – seeing something in both sides of most polarities – feeling uncomfortable with the zealots on either side of the fence. It’s not that I don’t have opinions, I just don’t trust them. In this week’s scene in Philadelphia, in spite of opinions and preferences, I can get on either side of a few of the elements in the mix. But sometimes, I feel that old unambiguous feeling from long ago, so I snuck some pictures into my opening collage that really don’t belong there. That’s DSM-5 Chairmen Darrel Regier and David Kupfer on the left at a hearing earlier in the year. The other picture is from last October’s Chair Summit<\/font><\/strong><\/a> – a CME neuroscience conference lead by Department Chairs in Psychiatry and Neurology. <\/p>\n

<\/p>\n

There is Charlie Nemeroff [until recently chair at Emory, now at Miami] – too toxic for public display but still in game. Next is Martin Keller [until recently chair at Brown], notorious PHARMA front-man of Paxil Study 329. And next to him, Alan Schatzberg [until recently chair at Stanford] – a widely discredited PHARMA guy, but still an active player. Jeffery Lieberman, APA president elect, and Schatzberg recently moderated an American Psychiatric Foundation summit with industry about how to make it easier for the Pharmaceutical Companies  to introduce new CNS drugs onto the market [APF Convenes Unique Pipeline Summit<\/font><\/strong><\/u><\/a>]. While Regier and Kupfer are less tarnished, their ideological taint is pernicious [and they don’t seem to even know it’s there]. I threw in Tom Insel, Director of the NIMH, since he’s also in Philadelphia talking to reporters<\/font><\/strong><\/u><\/a> creating his own illusions: <\/p>\n

\n
    \n
    Thomas R. Insel, a psychiatrist who directs the National Institute of Mental Health, sees psychiatry heading toward what he calls "clinical neuroscience." Psychiatrists should study the brain the way cardiologists study the heart, he said. <\/em>"There is no biochemical imbalance that we have ever been able to demonstrate. What we think about are changes in circuitry and how the brain is processing information."<\/sup><\/div>\n<\/ul><\/div>\n
    So returning to my comments from the Future of an Illusion<\/font><\/strong>, I still see way too many psychiatrists in power captured by an illusion [and way too many who have capitalized on that illusion] to be hopeful about what’s going on inside the Convention Hall in Philadelphia this week. I find myself feeling unambivalently negative about the current leadership in psychiatry that’s still running on the inertia of a three decade long unholy alliance with the Pharmaceutical Industry in spite of repeated wake-up calls. It’s not a good time…<\/div>\n
    \n
    Note<\/strong>: An earlier version had an error, confusing J. Lieberman and M. Keller in the photo.<\/div>\n","protected":false},"excerpt":{"rendered":"

    "I didn’t know whether to laugh or cry. Laugh — because there is no way task force and work group members can be made to refrain from discussing the developing DSM-V with their colleagues. Cry — because this unprecedented attempt to revise DSM in secrecy indicates a failure to understand that revising a diagnostic manual […]<\/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_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-22925","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22925","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=22925"}],"version-history":[{"count":45,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22925\/revisions"}],"predecessor-version":[{"id":22974,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/22925\/revisions\/22974"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=22925"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=22925"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=22925"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}