\nLeading psychiatrists question psychiatry’s diagnostic manual<\/a>
Fox News<\/font><\/strong>
By Dr. Keith Ablow
November 12, 2012<\/div>\n<\/p>\n
With the new American Psychiatric Association Diagnostic and Statistical Manual V [DSM V] slated for publication next year, leaders in American psychiatry are criticizing the volume as unreliable. The DSM is the compendium of conditions psychiatrists use to diagnose their patients and, to a great extent, determine what treatments would benefit them. The DSM also has extremely important implications for what kinds of psychiatric problems insurers will cover and even which ones schools and employers will consider disabilities. Dr. Allen Frances, professor emeritus at Duke University, who was actually the chairman of the DSM-IV task force, asserts in a recent blog published that the clinical trials that supposedly determined whether the new DSM V is a good and accurate guide “have been a pure disaster from start to finish.” He calls the trials a “fiasco” and accuses the American Psychiatric Association of having “lost its competence and credibility”…<\/p>\nGiven the concerns of leading psychiatrists like Frances, with whom I happen to agree, it is time to give real consideration to fundamentally changing the way psychiatrists use the DSM and encouraging them to think much more about what caused the disorders they are diagnosing. This is the proposal of one of the most influential psychiatrists of our time, Dr. Paul McHugh. McHugh is Chairman Emeritus of Psychiatry at Johns Hopkins. He and his esteemed colleague Dr. Phillip Slavney have written in the New England Journal of Medicine that the DSM is just a list of conditions with signs and symptoms and offers “no way of making sense of mental disorders.” Making sense of mental illnesses—describing the patient’s actual suffering and disability—is imperative because pretending that people can be understood by giving them a label like major depressive disorder misses the fact that many actually complain mostly about anxiety, many others are actually grieving the loss of a loved one, and many others have pervasive low mood, low energy and low self-esteem that came “out of the blue.” <\/p>\n
McHugh and Slavney correctly wonder whether this sloppiness in simply labeling rather than truly understanding patients explains why antidepressant medicines — if they are being given to a very diverse group of people artificially lumped together by the DSM — don’t seem to work much better than placebo. Why would they, if half the people who meet the criteria for major depression actually have other, central issues to address? Focusing on causes would reawaken psychiatry’s commitment to looking at people’s life stories as relevant to their suffering…<\/p>\n
McHugh and Slavney say it is time to enrich and augment the checklist method of making diagnoses by starting to group mental disorders into the underlying causes: [roughly translated from their wording] brain diseases, personality problems, behavioral problems and life stresses. The McHugh and Slavney perspective is a valuable one. Given the rising chorus of concern about DSM V, their thoughts, as well as those of Dr. Frances and of autism advocates and of many others should translate into delaying publication of the DSM-V, until it can incorporate a new respect [which is a very old idea, indeed] for how patients got sick, to begin with, and how, therefore, they can get well.<\/strong><\/sup><\/div>\n<\/blockquote>\n
Having weighed in on the DSM-5 on this blog and as a recent contributor to another commentary<\/a>, I found Dr. Lieberman’s response to Dr. Ablow today disappointing, perhaps even kind of sad: <\/div>\n\n