{"id":36439,"date":"2013-05-19T11:20:59","date_gmt":"2013-05-19T15:20:59","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=36439"},"modified":"2013-05-19T11:29:14","modified_gmt":"2013-05-19T15:29:14","slug":"dont-know-what-else-to-do","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/05\/19\/dont-know-what-else-to-do\/","title":{"rendered":"don&#8217;t know what else to do&#8230;"},"content":{"rendered":"<div align=\"justify\">I suppose that this kind of defensive opening Press Conference was to be expected. And they chose to defend criticisms of specific decisions made along the way. I&#8217;ve added just a few comments along the way, but they missed the overall point of the major criticisms of their [now released] DSM-5.     <\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.medpagetoday.com\/MeetingCoverage\/APA\/39241\" target=\"_blank\">APA Leaders Defend New Diagnostic Guide<\/a><br \/>        <strong><font color=\"#200020\">MedPage Today<\/font><\/strong><br \/>        By John  Gever<br \/>        May 18, 2013<\/div>\n<div align=\"justify\"><sup><strong>         <\/p>\n<p align=\"justify\">The fifth edition of the &quot;psychiatrist&#8217;s bible&quot; was  officially released here in all its 947-page glory, with its developers  offering a spirited rebuttal to their critics. Known as DSM-5, the new version of the American Psychiatric Association&#8217;s [APA] <em>Diagnostic and Statistical Manual of Mental Disorders<\/em>  was launched at a press briefing to kick off the organization&#8217;s annual  meeting. Most of the changes from the previous edition had already been  made public, at least in general outline.<\/p>\n<p align=\"justify\">At the briefing, DSM-5  Task Force chairman David Kupfer, MD, of the University of Pittsburgh,  defended several of the most heavily criticized revisions from DSM-IV,  as the last edition was called. Other top APA leaders, including  current president Dilip Jeste, MD, of the University of California San  Diego, and president-elect Jeffrey Lieberman, MD, of Columbia University  in New York City, addressed another, more recent controversy over  DSM-5, which was sparked by a <a target=\"_blank\" href=\"http:\/\/www.medpagetoday.com\/Psychiatry\/DSM-5\/39232\">blog post<\/a> from National Institute of Mental Health [NIMH] Director Thomas Insel, MD. In  his blog, Insel criticized the DSM classification system&#8217;s scientific  validity, and his remarks were then reported in consumer media as  suggesting DSM-5 is &quot;out of touch with science,&quot; as a <em>New York Times<\/em> headline put it.<\/p>\n<div align=\"justify\">Kupfer  identified several specific changes from DSM-IV in the new edition that  had drawn the most heat from others in the mental health community and  patient advocacy groups&#8230;<\/div>\n<ul>\n<li>\n<div align=\"justify\"><font color=\"#200020\">Autism Spectrum: &#8230;<\/font><\/div>\n<\/li>\n<li>\n<div align=\"justify\"><font color=\"#200020\">Bereavement Exclusion in Major Depression: &#8230;<\/font><br \/>        APA fact sheet distributed at the briefing  pointed to several features that &quot;usually&quot; distinguish depressive  illness from normal grief in patients experiencing recent losses. They  include continuous unrelieved negative mood and feelings of  worthlessness and self-loathing. In normal grief, extreme sadness is  typically intermittent and self-esteem is unaffected, the fact sheet  said.<\/div>\n<\/li>\n<\/ul>\n<p>    <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I just thought this was kind of funny. In the DSM-5, they distinguish grief and depression by duration of symptoms, yet in this handout, they differentiate them by specific findings [self loathing]. The funny part is that they are essentially quoting Freud&#8217;s 1917 <a href=\"http:\/\/www.barondecharlus.com\/uploads\/2\/7\/8\/8\/2788245\/freud_-_mourning_and_melancholia.pdf\" target=\"_blank\"><em><strong><font color=\"#200020\">Mourning and Melancholia<\/font><\/strong><\/em><\/a> without attribution.    <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>    <\/p>\n<ul>\n<li>\n<div align=\"justify\"><font color=\"#200020\">Disruptive Mood Dysregulation Disorder (DMDD]: &#8230;<\/font><br \/>       The  diagnosis &quot;is intended, in part, to address issues about potential  overdiagnosis and overtreatment of bipolar disorder,&quot; Kupfer said.<\/div>\n<\/li>\n<\/ul>\n<p>    <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">If they wanted to clarify Childhood Bipolar Disorder, they could&#8217;ve done that directly. Instead, the created another fictitious heterogeneous Disorder that can be overmedicated. What were they thinking, I wonder?    <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>    <\/p>\n<ul>\n<li>\n<div><font color=\"#200020\">Mild Neurocognitive Disorder:<\/font><br \/>          In  a critique of DSM-5 published on the eve of its launch, the head of  DSM-IV&#8217;s development in the 1980s, Allen Frances, MD, of Duke University  in Durham, N.C., singled out the new edition&#8217;s inclusion of mild  neurocognitive disorder as another example of medicalizing normal  function&#8230; &quot;There has been concern that we  may have added a disorder that may not be important enough to merit  clinical attention,&quot; Kupfer said&#8230; &quot;Clinicians  have lacked a reliable diagnosis to assess such [impairments] and to  understand what might be the most appropriate treatment or services,&quot;  Kupfer said. Including mild neurocognitive disorders in DSM-5  &quot;serves two essential needs,&quot; he said. One is that it provides &quot;an  opportunity for early detection,&quot; while another is that it &quot;encourages  the development of an effective treatment plan before deficits become  more pronounced and progress to dementia.&quot;<\/div>\n<\/li>\n<\/ul>\n<p>    <\/strong><\/sup><\/div>\n<\/blockquote>\n<div>Again, missing on purpose Dr. Frances&#8217; point that this is a black hole for false positives created based on no data. It&#8217;s an example of their doing &quot;pretend prevention&quot; without their beloved &quot;evidence base.&quot;    <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>    <\/p>\n<ul>\n<li>\n<div align=\"justify\"><font color=\"#200020\">Insel&#8217;s Comments: &#8230;<\/font><br \/>        Apparently  without meaning to, Insel set off a firestorm with an April 29  &quot;director&#8217;s blog&quot; post on the NIMH website, in which he lamented that  the DSM  &#8211;  not just the new edition but its predecessors as well  &#8211;   is not grounded solidly in biology. Rather, he said, &quot;the DSM diagnoses  are based on a consensus about clusters of clinical symptoms, not any  objective laboratory measure.<\/div>\n<\/li>\n<\/ul>\n<p>    <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">If I may be candid, &quot;without meaning to&quot; my ass! Insel was grandstanding and it backfired. What&#8217;s worse. The DSM-5 Task Force agrees with Insel since their opening gambit in 2002. They were as disappointed with the DSM-5 they ultimately created as the rest of us, but they got over it as the deadlines approached.    <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>    <\/p>\n<ul>\n<div align=\"justify\">At the press briefing here, APA officials reiterated that there is, in fact, no disagreement with Insel.  &quot;We support what he&#8217;s trying to do,&quot; said John Scully, MD, the APA&#8217;s chief executive officer. &quot;We want him to get biomarkers for us.&quot;  Added Lieberman, &quot;He [Insel] was trying to exhort the biomedical research community to try to break new ground that will lead to more dynamic and fundamental changes in psychiatric diagnosis.&quot;  Yet, Kupfer suggested, the flaws in DSM-IV for daily clinical practice needed to be addressed in the short term, and an extension of the symptom-based approach remained the only alternative.  &quot;While we don&#8217;t yet have the biomarkers that we are hoping are on the edge of discovery, patients can&#8217;t keep waiting, and we can&#8217;t keep waiting,&quot; he said.<\/div>\n<\/ul>\n<p>    <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">The DSM-5 Task Force spent years and untold amounts of money chasing the same dream Insel has to no avail. What they didn&#8217;t do was revise the DSM-IV which was in need of attention by all accounts [including that of Dr. Frances who directed that revision],  and was <u>their assigned task<\/u>. They ignored the fact that the most common diagnostic category, Major Depressive Disorder, has been hopelessly flawed from day one [1980] and should have been an abiding concern along with several other major categories. Instead, they piddled around trying to add some things that were immaterial and actually detracted. They were so taken with their expertise and ideologies that they failed to notice that the train was off the track and too deaf to hear people desperately trying to help them do their job.    <\/div>\n<blockquote>\n<div align=\"justify\"><sup><strong>    <\/p>\n<ul>\n<li><font color=\"#200020\">Other Criticisms &#8230;<\/font><\/li>\n<\/ul>\n<p>      <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">This Press Conference is an exemplar of what they&#8217;ve done for the whole time &#8211; try to explain themselves to people who know better, banking on an authority they think they have&#8230; but don&#8217;t. I wonder if they actually miss the point as badly as it appears, or if they just don&#8217;t know what else to do&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>I suppose that this kind of defensive opening Press Conference was to be expected. And they chose to defend criticisms of specific decisions made along the way. I&#8217;ve added just a few comments along the way, but they missed the overall point of the major criticisms of their [now released] DSM-5. APA Leaders Defend New [&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":[5],"tags":[],"class_list":["post-36439","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36439","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=36439"}],"version-history":[{"count":14,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36439\/revisions"}],"predecessor-version":[{"id":36453,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36439\/revisions\/36453"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=36439"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=36439"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=36439"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}