{"id":45185,"date":"2014-03-30T10:06:36","date_gmt":"2014-03-30T14:06:36","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=45185"},"modified":"2014-03-30T10:10:27","modified_gmt":"2014-03-30T14:10:27","slug":"the-summer-of-09","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/03\/30\/the-summer-of-09\/","title":{"rendered":"the summer of 09…"},"content":{"rendered":"
"I don’t want to be lying on my deathbed and asking, ‘What was all that about?’"<\/em><\/div>\n
attributed to<\/em> Marlon Brando<\/sup><\/div>\n

<\/p>\n

We’re approaching the one year anniversary of the release of the DSM-5, an event shrouded in confusion, contention, and disappointment. I don’t recall many of us paying very much attention to it before the summer of 09, though the revision process was by then a decade old. In June 2009, the leaders published something of a state of the revision<\/em> Commentary in the AJP. By then, the chairs had been appointed [April 2006], the Task Force [July 2007] and Workgroups [July 2008] populated, and work was underway. Although there had been an extensive series of symposia in the interim, this Commentary was little changed from their earlier book, A Research Agenda for the DSM-V<\/em>, published in 2002: <\/div>\n
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The Conceptual Development of DSM-V<\/a><\/div>\n
by Darrel A. Regier, William E. Narrow, Emily A. Kuhl, and David J. Kupfer<\/div>\n
American Journal of Psychiatry<\/font><\/strong>. 2009 166:645-650.<\/div>\n
[full text online<\/a>]<\/div>\n<\/blockquote>\n
While a lot of this Commentary is about their processes of the previous decade, there are several things of note. They reviewed the creation of the DSM-III from the Feighner criteria and the RDC, attributing it all to the influence of Robins and Guze, the neoKraepelinians. They talked about a 1980 expectation that subsequent basic research would validate those categories – something that hadn’t happened. They pointed to the high rates of comorbidity, the heavy use of the NOS designation, the fact that medications were not diagnosis specific, and the failure to find biological markers for the categories. They saw these things as evidence that it was time for a change in direction – a paradigm shift. Their solutions included [as always] finding the missing biomarkers, including biological correlates with the diagnoses, and adding "dimensional" elements to the diagnostic system – "cross-cutting dimensions."<\/div>\n
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The single most important precondition for moving forward to improve the clinical and scientific utility of DSM-V will be the incorporation of simple dimensional measures for assessing syndromes within broad diagnostic categories and supraordinate dimensions that cross current diagnostic boundaries. Thus, we have decided that one, if not the major, difference between DSM-IV and DSM-V will be the more prominent use of dimensional measures in DSM-V.<\/font><\/strong><\/div>\n<\/blockquote>\n
Neither Dr. Spitzer [DSM-III, DSM-IIIR] nor Dr. Frances [DSM-IV] were mentioned in this article even in passing. Perhaps Dr. Spitzer’s ommission had to do with his earlier calling the DSM-V Task Force out for its secrecy policies, but the reason for their omission of Dr. Frances and their general negativity towards the DSM-IV wasn’t clear [maybe they had a premonition]. Another thing, in spite of heavily referencing elsewhere in the article, this comment is reference-free:<\/div>\n
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… we have come to understand that we are unlikely to find single gene underpinnings for most mental disorders, which are more likely to have polygenetic vulnerabilities interacting with epigenetic factors [that switch genes on and off] and environmental exposures to produce disorders.<\/font><\/strong><\/div>\n<\/blockquote>\n
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Then, later that month, Dr. Frances spoke up. If you don’t know the story of why, it’s worth your time to read Gary Greenberg’s later article in Wired<\/em> that tells the story, Inside the Battle to Define Mental Illness<\/a>: <\/div>\n<\/div>\n
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A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences<\/a><\/div>\n
Psychiatric Times<\/font><\/strong> <\/div>\n
by Allen Frances <\/div>\n
June 26, 2009<\/div>\n
[full text online<\/a>]<\/div>\n<\/blockquote>\n
Frances summarizes his numerous concerns at the end of his article:<\/div>\n
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My concerns arise from the following: <\/font><\/strong><\/div>\n