{"id":42813,"date":"2014-01-03T13:30:27","date_gmt":"2014-01-03T18:30:27","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=42813"},"modified":"2014-01-03T13:46:25","modified_gmt":"2014-01-03T18:46:25","slug":"dsm-5-retrospective-iii","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/01\/03\/dsm-5-retrospective-iii\/","title":{"rendered":"DSM-5 retrospective III&#8230;"},"content":{"rendered":"\n<div align=\"justify\" class=\"small\">No retrospective of the DSM-5 process would be complete without a commentary from the summer of 2009, when things moved into the public arena. And there&#8217;s no better ringside commentator than Danny Carlat who was blogging the whole thing blow by blow. Senator Grassley&#8217;s Investigation was still in the news, and a few weeks before, Dr. Nemeroff&#8217;s pal Zach Stowe had been fingered for committing the same sins as his boss &#8211; unreported income for speaker gigs while on a grant from GSK. All hell broke loose when Allen Frances went public:          <\/div>\n<blockquote>\n<div align=\"center\" class=\"big\"><a target=\"_blank\" href=\"http:\/\/carlatpsychiatry.blogspot.com\/2009\/06\/psychiatrys-dsm-v-process-now-bar-room.html\">Psychiatry&rsquo;s DSM-V Process: Now A Bar Room Brawl <\/a><\/div>\n<div align=\"center\" class=\"big\"><strong><font color=\"#200020\">The Carlat Psychiatry Blog<\/font><\/strong><\/div>\n<div align=\"center\" class=\"middle\">by Danny Carlat<\/div>\n<div align=\"center\" class=\"small\">June 30, 2009 <\/div>\n<div align=\"center\" class=\"middle\">[<a href=\"http:\/\/carlatpsychiatry.blogspot.com\/2009\/06\/psychiatrys-dsm-v-process-now-bar-room.html\" target=\"_blank\">full text online<\/a>]<\/div>\n<p>        <\/p>\n<div align=\"justify\">Psychiatry&rsquo;s diagnostic manual is due for a  revision. But what began as a group of top scientists reviewing the  research literature has degenerated into a dispute that puts the Hatfield-McCoy feud to shame. The latest installment in this remarkable episode of American psychiatry involves an <a target=\"_blank\" href=\"http:\/\/www.beforeyoutakethatpill.com\/2009\/6\/Frances_DSM-5.pdf\">editorial by Dr. Allen Frances<\/a>,  the chairman of the committee that created the current version of the  the DSM, the DSM-IV. The editorial has not even been officially  published [it is in press at <em>Psychiatric Times<\/em>] but already it  has made the rounds of the blogs and is being read and debated widely.  Now, the APA has just released this rather stunning <a target=\"_blank\" href=\"http:\/\/www.scribd.com\/doc\/16953085\/PsychTimesFrancesResponse-062909-FINAL\">response<\/a>&#8230;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">First, Carlat summarizes Dr. Frances&#8217; criticisms of the developing DSM-5 [we know the back story from <a href=\"http:\/\/www.wired.com\/magazine\/2010\/12\/ff_dsmv\/all\/1\" target=\"_blank\">Greenberg&#8217;s 2010 article<\/a> in Wired].      <\/div>\n<blockquote>\n<div align=\"justify\">In his editorial, Dr. Frances criticizes the evolving DSM-V on multiple levels, and makes the following claims:<\/div>\n<div align=\"justify\">&bull; The  process of writing the manual is less transparent and less inclusive  than the process he oversaw when he chaired the DSM-IV committee.<\/div>\n<div align=\"justify\">&bull; The  underlying science of psychiatry has not advanced enough to merit the  kind of extreme makeover proposed by the DSM-V chairpeople:<\/div>\n<ul>\n<div align=\"justify\">&quot;The  simple truth is that descriptive psychiatric diagnosis does not need  and cannot support a paradigm shift. There can be no dramatic  improvements in psychiatric diagnosis until we make a fundamental leap  in our understanding of what causes mental disorders. The incredible  recent advances in neuroscience, molecular biology, and brain imaging  that have taught us so much about normal brain functioning are still not  relevant to the clinical practicalities of everyday psychiatric  diagnosis. The clearest evidence supporting this disappointing fact is  that not even one biological test is ready for inclusion in the criteria  sets for DSM-5.&quot;<\/div>\n<\/ul>\n<div align=\"justify\">&bull; The main change being proposed&mdash;the  official inclusion of a series of rating scales into the diagnostic  criteria&mdash;is poorly conceived because busy clinicians will reject this  extra paper-work.<\/div>\n<div align=\"justify\">&bull; Other proposed changes in DSM-V will make it too easy to over-diagnose a range of conditions:<\/div>\n<ul>\n<div align=\"justify\">&ldquo;The  result would be a wholesale imperial medicalization of normality that  will trivialize mental disorder and lead to a deluge of unneeded  medication treatment&#8211;a bonanza for the pharmaceutical industry but at a  huge cost to the new false positive &quot;patients&quot; caught in the  excessively wide DSM-V net. They will pay a high price in side effects,  dollars, and stigma, not to mentions the unpredictable impact on  insurability, disability, and forensics.&rdquo;<\/div>\n<\/ul>\n<div align=\"justify\">Frances&rsquo; article  is compelling, not only because of the substance of his arguments but  because of his clear and forceful writing style. With each sentence, you  get a sense that this man has carefully thought through all of these  issues and is passionately concerned about the future of his field.<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">All familiar: Secrecy, an unwarranted paradigm shift, superfluous rating scales, and the medicalization of normality with overdiagnosis and overmedication. Then Carlat summarizes the APA response from Alan Schatzberg, David Kupfer, Darrell Regier, and James Scully, which ends with:     <\/div>\n<blockquote>\n<div align=\"justify\">&ldquo;Both Dr. Frances and Dr. Spitzer have more than a personal &ldquo;pride of authorship&rdquo; interest in preserving the DSM-IV and its related case book and study products. Both continue to receive royalties on DSM-IV associated products. The fact that Dr. Frances was informed at the APA Annual Meeting last month that subsequent editions of his DSM-IV associated products would cease when the new edition is finalized, should be considered when evaluating his critique and its timing.&rdquo;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">Now look at the response to Dr. Carroll&#8217;s comments about the CAT-DI test signed by Robert D. Gibbons, David Weiss, Paul Pilkonis, Ellen Frank, Tara Moore, Jong Bae Kim, and David Kupfer [see <a href=\"http:\/\/1boringoldman.com\/index.php\/2013\/12\/29\/insider-trading\/\">insider trading&hellip;<\/a>]:<\/div>\n<blockquote>\n<div align=\"justify\">&quot;It is, however,  completely unclear that his lack of enthusiasm is based on any  scientifically rigorous foundation. Indeed, his knowledge of these  methods seems lacking. Finally, Carroll is quick to point out the  acknowledged potential conflicts of others as if they have led to bias  in reporting of scientific information. In this case, it is Carroll who  has the overwhelming conflict of interest. As developer, owner, and  marketer of the Carroll Depression Scale&ndash;Revised, a traditional  fixed-length test, it is not surprising that the paradigm shift  described in our article would be of serious concern to him.&quot;<\/div>\n<\/blockquote>\n<div align=\"justify\" class=\"small\">This latter response came before we knew of their commercial enterprise and the obvious COI for Drs. Kupfer and Frank.<\/div>\n<p align=\"justify\" class=\"small\">In our military, we have an article, Article 113: <strong><font color=\"#200020\">Conduct Unbecoming an Officer and a Gentleman<\/font><\/strong> [shortened now to <strong><font color=\"#200020\">Conduct Unbecoming an Officer<\/font><\/strong>]. Uncharacteristically, considering the usual military penchant for details, it&#8217;s very loosely defined. We don&#8217;t need a definition, because we all know what it means. It refers to the fact that we hold our leaders to a higher standard of conduct than the simple standards of the civil and criminal laws. There&#8217;s a similar implicit standard in Medicine.<\/p>\n<div align=\"justify\" class=\"small\">This era of the DSM-5 Revision spans the manipulative logic of <em>A Research Agenda for the DSM-V<\/em> through the response to Drs. Spitzer and Frances complaints to this recent reaction to the revelations about Drs. Gibbons and Kupfer and their opening salvo in response. There&#8217;s only one name that&#8217;s on all three documents &#8211; David Kupfer. There have been equally disturbing parallels throughout the the same time frame in the conduct of the psychiatric leadership, all well known to us all. The problems in psychiatry are not ideological, they&#8217;re Article 113 problems in our leadership, and the DSM-5 process is a paradigmatic example&#8230;<\/div>\n","protected":false},"excerpt":{"rendered":"<p>No retrospective of the DSM-5 process would be complete without a commentary from the summer of 2009, when things moved into the public arena. And there&#8217;s no better ringside commentator than Danny Carlat who was blogging the whole thing blow by blow. Senator Grassley&#8217;s Investigation was still in the news, and a few weeks before, [&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-42813","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42813","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=42813"}],"version-history":[{"count":26,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42813\/revisions"}],"predecessor-version":[{"id":42847,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/42813\/revisions\/42847"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=42813"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=42813"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=42813"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}