{"id":36689,"date":"2013-05-25T12:31:05","date_gmt":"2013-05-25T16:31:05","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=36689"},"modified":"2013-05-27T18:31:52","modified_gmt":"2013-05-27T22:31:52","slug":"didnt-know-that","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2013\/05\/25\/didnt-know-that\/","title":{"rendered":"didn&#8217;t know that&#8230;"},"content":{"rendered":"<div align=\"justify\"><em><sup><strong>But there&rsquo;s another type  of critique that does not contribute to this  goal. These are the groups  who are actually proud to identify  themselves as &ldquo;anti-psychiatry.&rdquo;  These are real people who don&rsquo;t want to improve mental healthcare,   unlike the dozens of psychiatrists, psychologists, social workers and   patient advocates who have labored for years to revise the DSM,   rigorously and responsibly. Instead, they are against the diagnosis and   treatment of mental illnesses &mdash; which improves, and in some cases  saves,  millions of lives every year &mdash; and &ldquo;against&rdquo; the very idea of  psychiatry,  and its practices of psychotherapy and psychopharmacology.  They are, to  my mind, misguided and misleading ideologues and  self-promoters who are  spreading scientific anarchy&hellip;<\/strong><\/sup><\/em><\/div>\n<div align=\"right\"><sup><em><strong><a href=\"http:\/\/blogs.scientificamerican.com\/mind-guest-blog\/2013\/05\/20\/dsm-5-caught-between-mental-illness-stigma-and-anti-psychiatry-prejudice\/\" target=\"_blank\">DSM-5: Caught between Mental Illness Stigma and Anti-Psychiatry Prejudice<\/a><br \/>    APA President Jeffrey Lieberman<\/strong><\/em><\/sup><\/div>\n<p>     <\/p>\n<div align=\"justify\">I&#8217;ve followed the <strong><font color=\"#200020\">stop-dsm<\/font><\/strong> movement in France for a while now [<a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2012\/11\/02\/cest-la-vie\/\">c&rsquo;est la vie&hellip;<\/a>, <a target=\"_blank\" href=\"http:\/\/1boringoldman.com\/index.php\/2013\/04\/08\/stop-dsm-european-style\/\">stop-dsm european style&hellip;<\/a>]. It&#8217;s a breath of fresh air from the contentious exchanges here in the US. Dr. Frances has posted a piece by one if their leaders, Patrick Landman, that responds to Lieberman&#8217;s recent rant. It&#8217;s refreshing to read someone from the other side of the world writing things that could be my own thoughts:<\/div>\n<blockquote>\n<div align=\"center\"><a href=\"http:\/\/www.huffingtonpost.com\/allen-frances\/is-criticism-of-dsm-5-ant_b_3326980.html\" target=\"_blank\">Is Criticism of DSM-5 &#8216;Anti-psychiatry&#8217;?<\/a><br \/>              <strong><font color=\"#006699\">Huffington Post<\/font><\/strong><br \/>               by Allen Frances<br \/>              05\/24\/2013<\/div>\n<div><sup><strong>              <\/p>\n<p align=\"justify\">&#8230;The latest in APA&#8217;s fluffy public relations has come from the president of the American Psychiatric Association. He has made two astounding claims  &#8211; that criticism of DSM-5 is somehow equivalent to criticism of  psychiatry and that it signifies stigma against mental illness. Patrick Landman, a prominent French psychiatrist who has written an  excellent book on DSM-5, wrote this rousing response to this new APA PR  offensive:<\/p>\n<ul>\n<div align=\"justify\">Let&#8217;s be clear &#8211; to oppose DSM-5 is not to oppose  psychiatry. Recently, the APA leadership has been  portraying all  opposition against DSM-5 as a form of anti-psychiatry. This is nonsense. Such rhetoric aims to discredit critics so that DSM-5 does not to  have to respond to their serious and well-documented arguments. Opposition to the DSM-5 methods and changes comes from all over the  world and includes tens of thousands of psychiatrists, clinical  psychologists, counselors, social workers and other mental health  practitioners. The people who oppose DSM-5 belong to many different schools of  thought, but unite in the worry that it is not safe or scientifically  sound. We are all deeply invested in psychiatry and cannot by any  stretch of the imagination be seen as anti-psychiatry. Indeed, we are  trying to save psychiatry from the errors of DSM-5.  <\/div>\n<p align=\"justify\">The stigma issue is equally a red herring. We are deeply concerned  with the dignity and rights of all users of psychiatry and committed to  the struggle against all forms of discrimination against the mentally  ill. Most who oppose DSM-5 do not reject the  classification of mental  disorders. We consider it essential for epidemiology, research, and  clinical work. What we do contest is the specific reliability, validity  and usefulness new DSM-5 diagnoses and also the closed and disorganized  way in which it was prepared.<\/p>\n<p align=\"justify\"><strong><img decoding=\"async\" width=\"70\" vspace=\"4\" hspace=\"4\" border=\"0\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/stop-dsm-2.gif\" \/><\/strong>Even those critics of DSM-5 who question its reductionistic  biomedical model do not question a biological contribution to mental  disorder. They are in favor of real scientific breakthroughs, but refuse  to accept a purely biological ideology. They do not reject the use of  medication when it is useful to bring about a patient&#8217;s remission or  recovery.<\/p>\n<div align=\"justify\">Finally, saying that the DSM-5 will lead to over-diagnosis and   over-medicalization of forms of behavior which for the longest time have  been perceived as part of normal human variation [such as mourning] and  that the DSM-5 will trigger new false epidemics and lead to  inappropriate drug prescriptions which may turn out to be dangerous [especially in children] has nothing whatsoever to do with  anti-psychiatry but rather accords with common sense and &#8230; yes, the  defense of psychiatry.<\/div>\n<\/ul>\n<div align=\"justify\">Thanks, Professor Landman. It would be wonderful to watch you debate  the APA president on this question- whether opposition to DSM-5 is  really pro-psychiatry or anti-psychiatry. We can safely bet who would  win, but also that such debate will never happen. APA Public Relations  would never approve it. So look for a continued flow of desperate APA puffery &#8211; and don&#8217;t be  surprised by the lack of DSM-5 substance. It is impossible to defend  the indefensible.<\/div>\n<p> <\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">The debate about the DSM-5 has taken many twists and turns along the way. Much of the opposition to it focuses on the motives of the revisers, the implications of the revisions, or the models used in its construction. Each of these points of view has merit, but to be honest, they&#8217;re not what bother me. What I don&#8217;t like about the DSM-5 is that it&#8217;s a lousy classification that I don&#8217;t find particularly helpful. I wasn&#8217;t in love with its predecessors, but I thought of them as benign &#8211; administratively necessary. This one doesn&#8217;t seem so benign to me. Although they couldn&#8217;t bring it off what they planned, it was ideologically driven and focused on a particular treatment modality. And then there&#8217;s this:<\/div>\n<blockquote>\n<div align=\"center\"><a target=\"_blank\" href=\"http:\/\/www.plosmedicine.org\/article\/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190\"><u><strong><font color=\"#200020\">A Comparison of <em>DSM<\/em>-IV and <em>DSM<\/em>-5 Panel Members&#8217; Financial Associations with Industry: A Pernicious Problem Persists<\/font><\/strong><\/u><\/a><\/div>\n<div align=\"center\"><strong><font color=\"#0033ff\">PLoS Medicine<\/font><\/strong><br \/>             by Lisa Cosgrove and Sheldon Krimsky<br \/>            March 13, 2012<\/div>\n<p>    <\/p>\n<div align=\"justify\"><sup><strong>  <\/p>\n<div><u>Summary Points<\/u><img decoding=\"async\" width=\"200\" border=\"0\" align=\"right\" src=\"http:\/\/1boringoldman.com\/images\/dsm5-workgroups.gif\" \/><\/div>\n<li>\n<div>The   American Psychiatric Association (APA) instituted a financial conflict   of interest disclosure policy for the 5th edition of the <em>Diagnostic and Statistical Manual of Mental Disorders<\/em> (<em>DSM<\/em>). <\/div>\n<\/li>\n<li>\n<div>The new disclosure policy has not been accompanied by a reduction in the financial conflicts of interest of <em>DSM<\/em> panel members. <\/div>\n<\/li>\n<li>\n<div>Transparency   alone cannot mitigate the potential for bias and is an insufficient   solution for protecting the integrity of the revision process. <\/div>\n<\/li>\n<li>\n<div>Gaps in APA&#8217;s disclosure policy are identified and recommendations for more stringent safeguards are offered. <\/div>\n<\/li>\n<p> <\/p>\n<div><u>Conclusion<\/u>:<\/div>\n<div>The DSM-5   will be published in about 14 months, enough time for the APA to   institute important changes that would allow the organization to achieve   its stated goal of a &ldquo;&hellip; transparent process of development for the <em>DSM<\/em>, and &hellip;an unbiased, evidence-based <em>DSM<\/em>, free from any conflicts of interest&rdquo; [emphasis added]. Toward that goal we believe it is essential that:<\/div>\n<ol>\n<li>\n<div>As an eventual gold standard and because of their actual and perceived influence, all <em>DSM<\/em> task force members should be free of FCOIs. <\/div>\n<\/li>\n<li>\n<div>Individuals who have participated on pharmaceutical companies&#8217; Speakers Bureaus should be prohibited from <em>DSM<\/em> panel membership. <\/div>\n<\/li>\n<li>\n<div>There should be a rebuttable presumption of prohibiting FCOIs among the DSM   work groups. <font color=\"#990000\">When no independent individuals with the requisite   expertise are available, individuals with associations to industry could   consult to the <em>DSM<\/em> panels, but they would not have decision-making authority on revisions or inclusion of new disorders. <\/font><\/div>\n<\/li>\n<\/ol>\n<div>These  changes  would accommodate the participation of needed experts as well  as provide  more stringent safeguards to protect the revision process  from either  the reality of or the perception of undue industry  influence.<\/div>\n<p><\/strong><\/sup><\/div>\n<\/blockquote>\n<div align=\"justify\">I think we are sooner or later going to have to adopt the policy that conflicts of interest of this type are <a href=\"http:\/\/en.wikipedia.org\/wiki\/Prima_facie\" target=\"_blank\">Prima Facie<\/a>  evidence [<em>&#8230;signify that on first examination, a matter appears to be self-evident from the facts<\/em>] that eliminates people from committees of this type or positions of power. The experiment with the idea that one can bend the old rule that even the <strong><font color=\"#200020\">appearance of a conflict of interest is exclusionary<\/font><\/strong> has been a disaster. If we didn&#8217;t know that before the DSM-5 process, we sure know it now. People can choose to either be paid by industry <u>or<\/u> involve themselves in academic and organized psychiatry &#8211; but not both. I would even disagree with the second sentence of their number <strong><font color=\"#200020\">3.<\/font><\/strong> above. I doubt policy makers are reading this blog looking for guidance or that I&#8217;ll be invited to the next APA Board of Trustees meeting to present it as a proposal [but I still think it].&nbsp; <\/div>\n<p align=\"justify\">One reason to follow the non-US perspectives is that the influence of insurance carriers and the pharmaceutical industry is less a factor in their systems. Currently, much of US psychiatry is shaped by the two industries, the government, and the legal system. I think that the consensus is that unless the specialty adapts to these external forces, it can&#8217;t survive &#8211; that there&#8217;s little choice and to think otherwise is naive. <\/p>\n<div align=\"justify\">I&#8217;m glad I didn&#8217;t know that&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>But there&rsquo;s another type of critique that does not contribute to this goal. These are the groups who are actually proud to identify themselves as &ldquo;anti-psychiatry.&rdquo; These are real people who don&rsquo;t want to improve mental healthcare, unlike the dozens of psychiatrists, psychologists, social workers and patient advocates who have labored for years to revise [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","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-36689","post","type-post","status-publish","format-standard","hentry","category-opinion"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36689","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=36689"}],"version-history":[{"count":44,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36689\/revisions"}],"predecessor-version":[{"id":42782,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/36689\/revisions\/42782"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=36689"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=36689"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=36689"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}