{"id":45243,"date":"2014-03-31T08:00:11","date_gmt":"2014-03-31T12:00:11","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=45243"},"modified":"2014-03-31T05:44:16","modified_gmt":"2014-03-31T09:44:16","slug":"the-endless-summer-of-09","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2014\/03\/31\/the-endless-summer-of-09\/","title":{"rendered":"the endless 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

In the last post, referring to the Schatzberg, Scully, Kupfer, Regier letter<\/a> in respsonse to Dr. Frances, I said, "That’s the low point of this story for me – a school playground bully response that has no place in any serious dialog.<\/em>" But in another way, it was a high point for the DSM-5 Revision enterprise, because after that, everything just seemed to continue to roll down hill.<\/p>\n

For one thing, at around this same time, Senator Grassley’s investigation of prominent psychiatrists who had under-reported their outside income was moving ahead full steam. And with that came the more widespread exposure of the research and marketing misconduct involving academic psychiatrists and the Pharmaceutical industry – along with legal suits that flushed out a stream of incriminating documents from the discovery process. If there had ever been a time for organized psychiatry to eat some humble pie, this was it. But that was not to be. In fact, the President of the APA was, himself, on Senator Grassley’s bad-boy list and one of the authors of the nastygram in response to Dr. Frances – Dr. Alan Schatzberg of Stanford. <\/p>\n

I don’t need to say anything about Dr. Frances’ campaign and the overwhelming support it received from outside psychiatry. You read about it in the popular media: Psychology Today<\/em>, Psychiatric Times<\/em>, Huffington Post<\/em>. There is a point I would make about it. Frances’ original complaint was primarily about the process of the DSM-5 Task Force, but the general reaction was more to some of the suggested diagnostic changes, to the exclusively biological focus, and to the suggested motive of the promotion of medications. While I wouldn’t argue with any of those things, there wasn’t much discussion of the actual Revision<\/font><\/strong> of the Diagnostic and Statistical Manual of Mental Illnesses<\/font><\/strong>. There were many places where the system had glaring problems that were even bigger than the limitations inherent in a descriptive classification. Two that come to mind are Major Depressive Disorder<\/em> and Generalized Anxiety Disorder<\/em> that were being used loosely in practice as synonyms for unhappy person<\/em> and nervous person<\/em>. My point? The main purpose of the revision got lost is the process. <\/p>\n

So back to things going downhill. The DSM-5 Task Force’s responses to the onslaught of criticism was either defensive, or pompous, or absent. I don’t know what was happening inside their bunker, but from out here, it looked like a stubborn silence. But, maybe they were just busy dealing with problems of their own. Recall that the paradigm shift that underpinned the DSM-5 Task force effort had two prongs: Adding in the biological findings to the DSM-5 Diagnostic Categories and the addition of of "Cross Cutting Dimensions." In July 2001, they had to come out publicly and admit that the findings they had banked on for the first part just hadn’t materialized. They made a big bet back at the turn of the century that the science they hypothesized would be there in time for the DSM-5, and it wasn’t. So:<\/div>\n
\n
Neuroscience, Clinical Evidence, and the Future of Psychiatric Classification in DSM-5<\/a><\/div>\n
by David J. Kupfer, M.D. and Darrel A. Regier, M.D., M.P.H.<\/div>\n
American Journal of Psychiatry<\/font><\/strong> 168:672-674, 2011.<\/div>\n
[full text online<\/a>]<\/div>\n<\/blockquote>\n
And by this time, the results of the DSM-5 Field Testing were expected, and the DSM-5 Task Force published this piece in the AJP preparing us for the not very encouraging results of the Field Trials [Alternative title: Don’t get your hopes up<\/em>]: <\/div>\n
\n
DSM-5: How Reliable Is Reliable Enough?<\/a><\/div>\n
by Helena Chmura Kraemer, David J. Kupfer, Diana E. Clarke, William E. Narrow, and Darrel A. Regier<\/div>\n
American Journal of Psychiatry<\/font><\/strong> 2012 169:13-15.<\/div>\n
[full text online<\/a>]<\/div>\n<\/blockquote>\n
Then along came what seemed like a natural extension of the mood of the times, the allegation that the industrial\/financial contamination that was being now discussed openly afflicted the very DSM-5 Task Force itself:<\/div>\n
\n
A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry:<\/a><\/div>\n
A Pernicious Problem Persists<\/font><\/strong><\/div>\n
PLoS Medicine<\/font><\/strong><\/div>\n
by Lisa Cosgrove and Sheldon Krimsky<\/div>\n
March 13, 2012<\/div>\n
[full text online<\/a>]<\/div>\n<\/blockquote>\n
While the Field Trial results were presented at the APA meeting in the summer of 2012, they weren’t published until later, right before the final meeting of the APA Board of Trustees where the decisions were made about what stayed and what went. The results were terrible, no better than the DSM-II that started this whole series based on reliability:<\/div>\n
<\/div>\n
The DSM-5 Revision process had appeared on the radar screen for most of us when Dr. Spitzer and later Dr. Frances brought it to our attention. Before that, it had mainly been something the APA insiders were involved in, but certainly not part of the everyday parlance of the man on the street, or for that matter, the psychiatrist, psychologist, social worker, etc. on the street. And while both of the former Task Force leaders knew there was something wrong, their comments about the process were lost in the din of scandal and objections to the particularly objectionable changes they proposed – like the disappearing Bereavement Exclusion, or the Psychosis Risk Syndrome nee Attenuated Psychosis Syndrome, or the changes in ADHD or Autism. Those of us who criticized their DSM-5 proposals pointed to the fact that many changes were weighted towards more medication, more overdiagnosis, etc, and those were important things to focus on to be sure. <\/div>\n

By the time the Board of Trustees was given the final draft,  many of the really shaky additions had fallen by the wayside [like the Attenuated Psychosis Syndrome] and they’d given up on the dream of adding the biomarkers and biological correlates to the mix [because there weren’t any]. The fact that the parts of the DSM-IV that had needed an overhaul had been ignored was itself ignored. The only thing left of the grand plan from the 2002 book [A Research Agenda for the DSM-V<\/a>] or the 2009 Commentary [The Conceptual Development of DSM-V<\/a>] was the addition of "Dimensions" to the diagnostic scheme. The Board of Trustees wisely said no to the proposed version. <\/p>\n

So it was a bust all around, a failed enterprise, a New Coke, an Edsel. Said journalist Benedict Carey<\/a>:<\/div>\n
\n
"They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations…" "… many experts inside and outside the process said the final document was not radically different from the previous version, and its lessons more mundane than the rhetoric implied."<\/div>\n<\/blockquote>\n
Said Robert Burns:<\/div>\n
\n
But, Mousie, thou art no thy lane,
In proving foresight may be vain;
The best-laid schemes o’ mice an’ men
Gang aft agley,
And lea’e us nought but grief an’ pain
For promised joy!<\/p>\n
To a Mouse On Turning her up in her Nest with the Plow by Robert Burns<\/div>\n<\/div>\n<\/blockquote>\n
Is there anything more to say as the first anniversary approaches? Maybe… <\/div>\n","protected":false},"excerpt":{"rendered":"

"I don’t want to be lying on my deathbed and asking, ‘What was all that about?’" attributed to Marlon Brando In the last post, referring to the Schatzberg, Scully, Kupfer, Regier letter in respsonse to Dr. Frances, I said, "That’s the low point of this story for me – a school playground bully response that […]<\/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_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-45243","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45243","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=45243"}],"version-history":[{"count":41,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45243\/revisions"}],"predecessor-version":[{"id":45289,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/45243\/revisions\/45289"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=45243"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=45243"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=45243"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}