{"id":34325,"date":"2013-03-17T20:41:46","date_gmt":"2013-03-18T00:41:46","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=34325"},"modified":"2013-03-17T20:52:55","modified_gmt":"2013-03-18T00:52:55","slug":"of-mammoth-proportions","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/03\/17\/of-mammoth-proportions\/","title":{"rendered":"of mammoth proportions&#8230;"},"content":{"rendered":"<div align=\"justify\">I&#8217;ve been thinking about the DSM-5 a lot more than I&#8217;d like lately, but in the process I&#8217;ve at least clarified a few points in my own mind &#8211; strewn about below in no particular order:<\/div>\n<ul><sup><strong>       <\/p>\n<li>\n<div align=\"justify\">The worst thing is something that didn&#8217;t actually make it into the manual, but I&#8217;ve talked about it ad nauseum here. They actually set out to create a diagnostic manual that was organized along biological\/neuroscience lines &#8211; even though they didn&#8217;t have direct evidence to support such a move. They wanted to use the power of the APA and the DSM&#8217;s place in mental health to put forward a theory of mental illness that is speculative and self-serving to a specific group. That was exactly the wrong that Dr. Spitzer&#8217;s DSM-III was designed to set right. They spent a few million have conferences\/symposiums to collect justifying evidence, and it wasn&#8217;t there to be collected. From my point of view, this was the negative legacy from Dr. Spitzer, Dr. Sabshin, and the Saint Louis group&#8217;s power grab in 1980 &#8211; the tradition that a select group in the APA defined the psychiatry in specific and mental health care in general. I attribute the closed shop nature of their deliberations to be part of this tradition, something like the &quot;Invisible College&quot; of the DSM-III years. They couldn&#8217;t bring it off, but the fact that they tried so hard discolors the whole process in my estimation. It was an agenda driven enterprise that has the biological momentum in the spaces between the words. When they had to admit that they had no solid basis to <em>go bio<\/em>, there was a campaign from every corner assuring us that it would soon be with us. This is not a revision. It is a failed attempt to force a paradigm shift by changing the manual, just like their predecessors in 1980 had done. And from my vantage, that&#8217;s all it is.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">The justification for many of the changes they did make had to do with making sure patients got treated &#8211; removing the bereavement exclusion being the prime example but there are plenty of others. Who&#8217;s to say that the American Psychiatric Association is tasked to tell us who to treat and who not to treat, or even how to treat. They&#8217;ve already bludgeoned us enough with their treatment guidelines. Again, it&#8217;s more Big Brother stuff &#8211; a function that I don&#8217;t recall being in the APA charter. Their guidelines and treatment oriented diagnostic changes are uniformly way too trigger happy with the current biological agents available &#8211; and they make mincemeat out of their claims to be conflict-of-interest free.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">Twenty-five years ago, using <em>expert opinion<\/em> was understandable. But here on the fourth iteration, it&#8217;s ludicrous to claim to be an evidence-based specialty and still be relying on experts most of whom are academics doing biological research with heavy pharmaceutical ties, whether they&#8217;ve been suspended for the duration of the task force or not. They had 13 symposiums on ways to <em>go bio<\/em> but not on the diagnosis of clinical syndromes. And their recurrent proclamations with the expert-counts fall on dead ears.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">The lack of deference shown to our colleagues in other mental health specialties was a blatant insult to all concerned. The only group who thinks mental illness is a big brain thing are the people on the DSM-5 Task Force and their friends. The overwhelming majority of mental health practitioners who use the manual don&#8217;t think mental illness is all biological and couldn&#8217;t do anything about it if they did. If they didn&#8217;t feel insulted, they should have.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">There are areas in the DSM-III, III-R, IV like MDD and GAD that are just plain wrong that weren&#8217;t even touched. Any fool who sees a patient with Melancholia knows that it&#8217;s not a sibling, not even a cousin, of the patient who comes to an office or volunteers for a Clinical Trial saying, &quot;I&#8217;m depressed.&quot; &quot;The blues&quot; and &quot;the black dog&quot; are different species. Just ask them.<\/div>\n<\/li>\n<li>\n<div align=\"justify\">I am a medical physician who came into psychiatry belatedly, after my medical identity was consolidated. As a medical physician, I&#8217;m embarrassed when the so-called scientists on this Task Force talk. The don&#8217;t sound &quot;medical&quot; &#8211; they sound like <em>wanna-be<\/em>s. We have some real scientists in our midst, but I don&#8217;t hear them beating the drum for the DSM-5. My guess is that they&#8217;re embarrassed just like I am.<\/div>\n<\/li>\n<p>      <\/strong><\/sup><\/ul>\n<div align=\"justify\">So it&#8217;s not just the details on the DSM-5 that I oppose. It&#8217;s the whole gestalt, the culture and process that created it. It&#8217;s the hubris of the APA to condone and protect this kind of arrogant pseudo-expertise. I don&#8217;t know if a solidified boycott movement will come together. I kind of hope so because the DSM-5 is not something people should be using. But in the long run, this is going to be a black day in the history of psychiatry, adding to our problems rather than helping us solve them. I feel most concerned about the legitimate biological researchers because this is going to leave a very bad taste that will linger long. That brings me to my last complaint:<\/div>\n<ul><sup><strong> <\/p>\n<li>\n<div align=\"justify\">The DSM-5 Revision was an opportunity to right a lot of wrongs.&nbsp; The DSM-III, for all its foibles, did do that. This Task Force didn&#8217;t. If I can make an forced analogy, it&#8217;s like what would&#8217;ve happened if instead of Dr. Spitzer, they had turned the DSM-III Revision over to a committee from the American Psychoanalytic Association. While a little more representation from that group might have been a good idea, it sure wasn&#8217;t a time to give them the reins. This DSM-5 Task Force was composed of and run by the very people that needed the reforming &#8211; and that&#8217;s my biggest complaint. We all knew that was true all along, but only a few brave souls said anything. This was a missed opportunity of mammoth proportions&#8230;<\/div>\n<\/li>\n<p>      <\/strong><\/sup><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>I&#8217;ve been thinking about the DSM-5 a lot more than I&#8217;d like lately, but in the process I&#8217;ve at least clarified a few points in my own mind &#8211; strewn about below in no particular order: The worst thing is something that didn&#8217;t actually make it into the manual, but I&#8217;ve talked about it ad [&hellip;]<\/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-34325","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34325","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=34325"}],"version-history":[{"count":3,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34325\/revisions"}],"predecessor-version":[{"id":42779,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/34325\/revisions\/42779"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=34325"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=34325"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=34325"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}