Posts Tagged ‘Diagnostic and Statistical Manual of mental disorders’

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Latest list of mental disorders leaves a bad taste in one’s mouth

Thursday, January 26th, 2012

The StarPhoenix January 26, 2012

by Les MacPherson

 It has come to my attention that I am mentally ill.

I always knew I was neurotic – who isn’t? – but it still comes as something of a surprise to learn that I am suffering from an actual mental illness. Others, perhaps, will not be surprised in the least.

The particular mental illness that afflicts me was added only recently to the so-called Bible of psychiatry, otherwise known as the Diagnostic and Statistical Manual of Mental Disorders. This is the big reference book that officially catalogues all the mental illnesses recognized by modern psychiatry. The latest edition is nearly 1,000 pages. You would have to be almost pathologically normal to find nothing in there that applies to you.

Qualifying as entirely sane does not get any easier when new disorders are regularly added to the already voluminous manual. The goalposts of sanity now have been moved so close together that I can no longer squeeze through.

What afflicts me is one of the latest additions proposed for the diagnostic manual, something called avoidant/ restrictive food intake disorder, or ARFID. Until recently, people suffering from this disorder were dismissed as picky eaters. Now, we suddenly are sick and need help.

ARFID is defined as an “eating or feeding disturbance” that includes avoiding foods of a particular taste, colour or texture. That’s exactly what I do. I avoid foods if the taste is bad, if the texture is lumpy or slimy and if the colour is grey, green or mottled beige. If this makes me mentally ill, I plead not hungry by reason of insanity.

Consider oatmeal, for example, a slimy, lumpy, grey food I have always found unspeakably horrible. I always thought it was the people who liked oatmeal who were mentally ill. And yet it clearly is not them but me whose symptoms are to be described in psychiatry’s foremost diagnostic textbook. Well, I don’t care what the doctors say, I still hate oatmeal.

I hate liver, too. If there was a religion that forbade eating liver, I would sign on as a missionary: Eat not of the liver, for it is an unclean thing, and also slimy, with a putrid taste and disgusting appearance. Whosoever filleth his mouth with liver, whether cooked with bacon or not, shall be cast into the fiery pit, along with some fried onions.

This is somewhat by the way, but notice how easily mental illness is repurposed as theology. It goes the other way, too, when the mentally ill are afflicted with religious delusions. I have never heard of a mentally ill person yet who thought he was a newspaper columnist, incidentally, except, of course, for those who really are newspaper columnists.

If it was just liver and oatmeal that provoked my involuntary gag reflex, I probably would not need professional help. There are many other foods, however, that I would rather wrap in a napkin and secretly slip into my pocket than eat. Among them are broccoli, spinach and all organ meats except the baloney. Heart, lungs or tongue will be scraped off my plate untouched, but I do like a thin slice of baloney, in a sandwich with lettuce and a little mustard.

I also cannot eat anything smothered in cream sauce. Any food that could possibly be improved by immersion in cream sauce I would dispose of as hazardous waste.

Asparagus likewise disgusts me. Fish, too, I mostly find off-putting. It doesn’t help when I am told that this particular fish dish has no fishy taste. Why would anyone want to eat something that is not supposed to taste like what it is? I wouldn’t eat beef, either, if the best that could be said of it was that it had no beefy taste. And I’m supposed to be the crazy one?

Now that picky eating is to be regarded as a mental illness, we can perhaps look forward to a cure. The big pharmaceutical companies probably are working even now on new drugs to treat the disorder. Imagine a pill that could make me like liver.

I’d spit it out when no one was looking.

http://www.thestarphoenix.com/health/Latest+list+mental+disorders+leaves+taste+mouth/6052784/story.html

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7 Reasons America’s Mental Health Industry Is a Threat to Our Sanity

Friday, January 6th, 2012

Drug industry corruption, scientifically unreliable diagnoses and pseudoscientific research have compromised the values of the psychiatric profession.

Alternet
By Bruce E. Levine
January 6, 2012

Why do some of us become dissident mental health professionals?

The majority of psychiatrists, psychologists and other mental health professionals “go along to get along” and maintain a status quo that includes drug company corruption, pseudoscientific research and a “standard of care” that is routinely damaging and occasionally kills young children. If that sounds hyperbolic, then you probably have not heard of Rebecca Riley, and how the highest levels of psychiatry described her treatment as “appropriate and within responsible professional standards.”

When Rebecca Riley was 28 months old, based primarily on the complaints of her mother that she was “hyper” and had difficulty sleeping, psychiatrist Kayoko Kifuji, at the Tufts-New England Medical Center in Boston, Massachusetts, diagnosed Rebecca with attention deficit hyperactivity disorder (ADHD). Kifuji prescribed clonidine, a hypertensive drug with significant sedating properties, a drug Kifuji also prescribed to Rebecca’s older sister and brother. The goal of the Riley parents—obvious to many in their community and later to juries—was to attain psychiatric diagnoses for their children that would qualify them for disability payments and to sedate their children making them easy to manage.

By the time Rebecca was three years old, again based mainly on parental complaints, Kifuji had given Rebecca an additional diagnosis of bipolar disorder and prescribed two additional heavily sedating drugs, the antipsychotic Seroquel and the anticonvulsant Depakote.

At the age of four, Rebecca was dead.

At the time of her death, Rebecca had a life-threatening amount of clonidine—enough to kill her—in her body, according to the former director of the Massachusetts toxicology lab and the medical director of a regional poison control center. The medical examiner who performed the autopsy concluded that Rebecca died from intoxication of clonidine, Depakote and two over-the-counter cold and cough medicines that led to heart failure, lungs filled with bloody fluid, coma, and then death. Rebecca’s abusive parents went to prison for the over-drugging that led to their daughter’s death.

Kifuji’s fate? The psychiatric establishment rallied around Kifuji, enabling her to return to Tufts Medical Center practicing child psychiatry without any restrictions, penalties or supervision. After Rebecca’s death, Tufts-New England Medical Center defended Kifuji. A Tufts spokesperson told “60 Minutes” in 2009, “The care we provided was appropriate and within responsible professional standards.”

Apparently, psychiatric care that is considered appropriate and within responsible professional standards includes diagnoses of ADHD for a two-year-old and bipolar disorder for a three-year-old when the symptoms of those disorders are normal behaviors for those ages; prescribing three heavily sedating drugs that have not been approved by the FDA for child psychiatric treatment; ignoring the warnings from a school nurse about over-dosages for Rebecca; and making diagnoses based almost entirely on the reports of Rebecca’s mother, who herself was diagnosed with mental illness and heavily medicated to the point of falling asleep in Kifuji’s office.

Long before the Rebecca Riley tragedy hit the headlines, I was embarrassed by the mental health profession for seven major reasons:

1. Corruption by Big Pharma

How did it become within responsible professional standards for a two-year-old to get an ADHD diagnosis, for a three-year-old to get a bipolar diagnosis, and for toddlers to be prescribed multiple heavily sedating drugs? The short answer is drug company corruption of the mental health profession.

Congressional hearings in 2008 revealed that psychiatry’s “thought leaders” and major institutions are on the take from drug companies.

On June 8, 2008, the New York Times reported about psychiatrist Joseph Biederman: “A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007.”

Due in large part to Biederman’s influence, the number of American children and adolescents treated for bipolar disorder increased 40-fold from 1994 to 2003. Pediatrician and author Lawrence Diller notes about Biederman, “He single-handedly put pediatric bipolar disorder on the map.” In addition to his popularization of bipolar disorder for children, Biederman is one of the most significant forces behind the expanding numbers diagnosed with ADHD; and congressional investigators also discovered that Biederman conducted studies of Eli Lilly’s ADHD drug Strattera that were funded by National Institute of Health at the same time he was receiving money from Lilly.

Not only does the drug industry have influential psychiatrists such as Biederman in their pocket, virtually every major mental health institution is financially interconnected with Big Pharma. Congressional hearings also exposed the American Psychiatric Association psychiatry’s premier professional organization, as being on the take from drug companies. In 2006, the drug industry accounted for about 30 percent of the APA’s $62.5 million in financing. Most relevant here, the APA is the publisher of the psychiatric diagnostic bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM), and thus the APA is the institution responsible for creating mental illnesses and disorders.

2. Invalid Illnesses and Disorders

Psychiatry’s first DSM (1952) and its DSM-II (1968) listed homosexuality as a mental illness. Only because of a fierce political fight waged in the 1970s by gay activists did the APA abolish homosexuality as an illness and eliminate it from its DSM-III (1980). Gay activists’ fight was not only a victory for themselves but a service for everyone else, as it made public the important scientific problem of psychiatric disorder invalidity. Specifically, are psychiatric disorders scientifically valid illnesses, or are they simply behaviors that create discomfort for some authorities at a given moment in time?

While psychiatry lost homosexuality as a mental illness in the 1980 DSM-III, the APA found other groups it could pathologize, groups that could not mobilize and resist, most notably children, who are now routinely given psychiatric diagnoses for behaviors that many of us view as normal for their ages.

Psychiatry sees it as within responsible professional standards to diagnose three-year-olds such as Rebecca Riley with bipolar disorder. The symptoms of bipolar disorder include irritable and rapidly changing moods, severe temper tantrums, defiance of authority, agitation and distractibility, sleeping too little or too much, poor judgment, impulsivity and grandiose beliefs.

Psychiatry also sees it as within responsible professional standards for Rebecca Riley to have been diagnosed at 28 months old with ADHD. The symptoms of ADHD are inattention (easily distracted and bored, difficulty organizing and completing tasks, losing things, not seeming to listen, not following instructions); hyperactivity (fidgeting, talking nonstop, having trouble sitting still, difficulty with quiet tasks), and impulsivity (impatience, blurting out inappropriate comments, interrupting conversations).

Today, children and teens are also diagnosed with oppositional defiant disorder (ODD), the symptoms of which include “often actively defies or refuses to comply with adult requests or rules,” and “often argues with adults.”

The standard for a medical disorder should not be whether or not an individual causes friction.

3. Scientifically Unreliable Diagnoses

Even if you believe that bipolar disorder for three-year-olds, ADHD for two-year-olds, ODD for teenagers, and all the other DSM diagnoses are valid disorders, there is still the scientific issue of diagnostic unreliability—the lack of diagnostic agreement among professionals examining the same person.

A generation ago, psychiatrists admitted that their diagnoses were unreliable and agreed that this was a major scientific problem. So in 1980, in an attempt to eliminate this embarrassment, they created the DSM-III with concrete behavioral checklists and formal decision-making rules, but they failed to correct the problem. Psychiatric diagnoses remain unreliable, but now psychiatry no longer talks about the unreliability problem.

If a measurement is a reliable one, then clinicians trained with it should be in high agreement on the diagnosis. A major 1992 study, conducted at six sites with 600 prospective patients, was done to examine the reliability of psychiatric diagnoses. Experienced mental health professionals were given extensive training in how to make accurate DSM diagnoses. Because of the extensive training, one would expect that diagnostic agreement would be much higher than in typical clinical settings. Herb Kutchins and Stuart Kirk summarize the study in Making Us Crazy (1997):

What this study demonstrated was that even when experienced clinicians with special training and supervision are asked to use DSM and make a diagnosis, they frequently disagree, even though the standards for defining agreement are very generous. . . . [For example,] if one of the two therapists made a diagnosis of Schizoid Personality Disorder and the other therapist selected Avoidant Personality Disorder, the therapists were judged to be in complete agreement of the diagnosis because they both found a personality disorder—even though they disagreed completely on which one! So even with this liberal definition of agreement, reliability using DSM is not very good.

Kutchins and Kirk conclude: “Mental health clinicians independently interviewing the same person in the community are as likely to agree as disagree that the person has a mental disorder and are as likely to agree as disagree on which of the over 300 DSM disorders is present.”

4. Biochemical Imbalance Mumbo Jumbo

Just as nothing was more important in selling the Iraq war in 2003 than the Bush administration’s certainty that Iraq possessed weapons of mass destruction, nothing has been more important in selling psychiatric drugs than psychiatry’s certainty of biochemical brain imbalances as the cause for mental illnesses.

Prior to psychiatry’s proclamation that depression was caused by too little of the neurotransmitter serotonin, few Americans were taking antidepressants. But by declaring that depression was caused by a serotonin imbalance analogous to diabetes and an insulin imbalance, depressed Americans became far more receptive to serotonin-enhancing drugs such as the “selective-serotonin-reuptake inhibitors” (SSRIs) Prozac, Paxil, and Zoloft.

SSRIs can make some depressed people feel better; however, alcohol makes some shy people less shy, but that’s not enough evidence to say that shyness is caused by an alcohol imbalance. The truth is—and scientists have known this for quite some time—that serotonin levels are not associated with depression.

Researchers have used a variety of methods to test the serotonin imbalance theory of depression, including comparing serotonin metabolites in depressed and nondepressed people, and depleting serotonin levels through a variety of means and then observing whether this resulted in depression. Elliot Valenstein, professor emeritus of psychology and neuroscience at the University of Michigan, reviewed the research in his book Blaming the Brain (1998) and reported that it is just as likely for people with normal serotonin levels to feel depressed as it is for people with abnormal serotonin levels, and that it is just as likely for people with abnormally high serotonin levels to feel depressed as it is for people with abnormally low serotonin levels. Valenstein concluded, “Furthermore, there is no convincing evidence that depressed people have a serotonin or norepinephrine deficiency.”

In 2002, the New York Times reported: “Researchers knew that antidepressants seemed to raise the brain’s levels of messenger chemicals called neurotransmitters, so they theorized that depression must result from a deficiency of these chemicals. Yet a multitude of studies failed to prove this precept.”

Yet even now, many psychiatrists and other mental health professionals continue to promulgate the serotonin imbalance theory of depression, and polls show that the majority of Americans continue to believe it.

5. Pseudoscientific Drug Effectiveness Research

There are multiple tricks that psychiatric drug manufacturers and their researcher psychiatrists and psychologists use to make their drugs look more effective than they really are. One of the most common depression measurements used by researchers paid by drug companies is the Hamilton Rating Scale for Depression. In the HRSD, researchers rate subjects, and the higher the point total, the more one is deemed to be suffering from depression. On the HRSD, there are three separate items about insomnia (early, middle and late) and one can receive up to six points for difficulty either falling or remaining asleep; however, there is only one suicide item, in which one is awarded only two points for wishing to be dead. The HRSD is heavily loaded with items that are most affected by drugs, and it is therefore especially damning for antidepressants that even with such measurement dice-loading, these drugs routinely fail to outperform placebos—even dice-loaded placebos.

Proper drug research requires that neither subject nor experimenter knows who is getting the drug and who is getting the placebo (a true double-blind control). Drug company antidepressant researchers use inactive placebos such as sugar pills (which don’t create side effects). Independent research on inactive placebos show that many subjects in antidepressant and other studies can guess if they are getting the actual drug or not, which changes their expectations and subverts the double-blind control. In order to make it more difficult to guess correctly, an active placebo (which creates side effects) should be used. In 2000, a Psychiatric Times article concluded: “In fact, when antidepressants are compared with active placebos, there appear to be no differences in clinical effectiveness.”

Dice-loading depression measurements and placebos are just two of many techniques drug company researchers use to make antidepressants look more effective than they really are. But even with such dice-loading, antidepressants have not fared well, at least when one examines all the studies.

Drug companies try to ensure that those studies showing antidepressants to be no more effective than placebos are not published; however, all studies must be submitted to the FDA. So independent researcher Irving Kirsch and his research team at the University of Connecticut used the Freedom of Information Act to gain access to all data, and analyzed 47 studies that had been sponsored by drug companies on Prozac, Paxil, Zoloft, Effexor, Celexa, and Serzone. Kirsch discovered that in the majority of the trials, the antidepressant failed to outperform a sugar pill placebo (and in the trials where the antidepressant did outperform the placebo, the advantage was slight).

6. Psychotropic Drug Hypocrisy

Chemists consider psychiatric prescription drugs and illegal mood-altering drugs all to be psychotropic or psychoactive drugs. Cocaine and ADHD drugs such as Adderall and other amphetamines affect the neurotransmitters dopamine, serotonin, and norepinephrine; and antidepressants used in combination also affect the same neurotransmitters. Not only are prescription psychotropics and illegal psychotropics chemically similar, they are used by people for similar reasons, including taking the edge off their discomfort so they can function. The hypocrisy surrounding illegal and prescription psychotropic drugs is harmful to society in at least two ways.

At one level, because people are being misinformed about the realities of prescription psychotropic drugs, they are more likely to gulp them down and to give them to their children. This has helped create a tragic phenomenon detailed by investigative reporter Robert Whitaker in his book Anatomy of an Epidemic (2010). Psychiatric drug use turning mild and episodic conditions into severe and chronic ones has helped create a huge increase of Americans with severe mental illness, especially among children.

At a second level, this psychiatric-illegal psychotropic drug hypocrisy allows for unfair criminalizing and incarceration of people using illegal psychotropics.

7. Diversion from Societal, Cultural and Political Sources of Misery

When we hear the words disorder, disease or illness, we think of an individual in need of treatment, not of a troubled society in need of transformation. Mental illness expansionism diverts us from examining a dehumanizing society.

In addition to pathologizing normal behavior, the mental health profession also diverts us from examining a society that creates the ingredients—helplessness, hopelessness, passivity, boredom, fear, and isolation—that cause emotional difficulties. We are diverted from the reality that many emotional problems are natural human reactions to loss in our society of autonomy and community. Thus, the mental health profession not only has financial value for drug companies but it has political value for those at the top of societal hierarchies who want to retain the status quo.

Today, a handful of dissident mental health professionals do challenge and resist their profession’s dehumanizing standard practices. I know several of these dissidents, and they are the only psychiatrists, psychologists and mental health professionals that I have any respect for.

Read article here:  http://www.alternet.org/story/153634/7_reasons_america%27s_mental_health_industry_is_a_threat_to_our_sanity/

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Psychiatry’s Flawed Tool: A book full of subjective checklists—the Diagnostic and Statistical Manual of Mental Disorders

Thursday, December 29th, 2011

First Things – December 29, 2011
by Joe Carter

Photo: Garry Mcleod; Origami: Robert Lang

Someday our grandchildren’s grandchildren are going to sitting in college classroom learning about the early 21st century and wonder how a society so seemingly advanced could have such primitive ideas about mental health.They will no doubt be shocked and appalled that our major diagnostic tool for psychiatry is a book full of subjective checklists—the Diagnostic and Statistical Manual of Mental Disorders (DSM versions I-IV).

I became all too familiar with the DSM in my college days, first as a psychology major and then as a behavioral science major (I switched because I believed behavioral science would be more scientifically rigorous. It wasn’t.) I was constantly shocked that such an utterly absurd book could be considered our primary mental health tool. The diagnostic criteria is often so vague that it is virtually impossible to determine if a patient truly has a mental disorder. Yet almost every diagnosis in America is made based on comparing a patient against the DSM’s checklist of “symptoms.”

Part of the reason the DSM is so flawed is because it is highly politicized. For example, homosexuality was classified in DSM as a sexual disorder until the 1970s. And until 1987, “ego-dystonic homosexuality” was still classified as a pathology. These “mental disorders” were later removed, not because of a change in empirical data (since there is none) but because of the protest of gay rights groups. I agree with the gay rights activists on this one: homosexuality should have never been classified as a mental disorder. But this example shows that the judgments made by psychiatrists are often highly subjective and are rooted more in speculative theories than in scientific fact. (Keep in mind that this is the same profession that, for almost a century, believed the Freudian idea that holding your feces in as an infant affected your personality as an adult.)

Such criticisms against the DSM have been made for decades (mostly by cranks like me) but they are gaining a new hearing because of who is now making them: Allen Frances, lead editor of the DSV-IV. As Frances says, “there is no definition of a mental disorder. It’s [BS]. I mean, you just can’t define it.” As Wired magazine notes:

Some of this disputatiousness is the hazard of any professional specialty. But when psychiatrists say, as they have during each of these fights, that the success or failure of their efforts could sink the whole profession, they aren’t just scoring rhetorical points. The authority of any doctor depends on their ability to name a patient’s suffering. For patients to accept a diagnosis, they must believe that doctors know—in the same way that physicists know about gravity or biologists about mitosis—that their disease exists and that they have it. But this kind of certainty has eluded psychiatry, and every fight over nomenclature threatens to undermine the legitimacy of the profession by revealing its dirty secret: that for all their confident pronouncements, psychiatrists can’t rigorously differentiate illness from everyday suffering. This is why, as one psychiatrist wrote after the APA voted homosexuality out of the DSM, “there is a terrible sense of shame among psychiatrists, always wanting to show that our diagnoses are as good as the scientific ones used in real medicine.”

Since 1980, when the DSM-III was published, psychiatrists have tried to solve this problem by using what is called descriptive diagnosis: a checklist approach, whereby illnesses are defined wholly by the symptoms patients present. The main virtue of descriptive psychiatry is that it doesn’t rely on unprovable notions about the nature and causes of mental illness, as the Freudian theories behind all those “neuroses” had done. Two doctors who observe a patient carefully and consult the DSM’s criteria lists usually won’t disagree on the diagnosis—something that was embarrassingly common before 1980. But descriptive psychiatry also has a major problem: Its diagnoses are nothing more than groupings of symptoms. If, during a two-week period, you have five of the nine symptoms of depression listed in the DSM, then you have “major depression,” no matter your circumstances or your own perception of your troubles. “No one should be proud that we have a descriptive system,” Frances tells me. “The fact that we do only reveals our limitations.” Instead of curing the profession’s own malady, descriptive psychiatry has just covered it up.

Read more . . .

http://www.firstthings.com/blogs/firstthoughts/2011/12/29/psychiatrys-flawed-tool/

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Therapists revolt against psychiatry’s bible

Wednesday, December 28th, 2011

Mental health professionals say new diagnoses will lead to overmedication

Salon Magazine, December 27, 2011

by Rob Waters

“epidemics of over-diagnosis in child psychiatry” have caused "huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications."

Anyone who’s ever tried to get reimbursed by a health insurance company after seeing a psychiatrist or psychotherapist, or taking a child or teenager to one, has no doubt noticed the incomprehensible numbers that appear on the clinician’s statement, perhaps preceding some slightly less imponderable phrase.

Maybe you are a 296.22 (major depressive disorder, single episode, mild) or a 300.00 (anxiety disorder NOS–not otherwise specified). Hopefully, you are not a 301.83 (borderline personality disorder). Your kid might be a 313.81 (oppositional defiant disorder) or, more likely, a 314.01 (attention deficit hyperactivity disorder, predominantly hyperactive-impulsive type).

Since 1952, a tome called the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been reducing to a few digits the psychological malady said to afflict a patient. This bible of mental health treatment, published by the American Psychiatric Association (APA), provides a list and description of every mental health condition known to—or invented by—psychiatry, from histrionic personality disorder (301.50) to transvestic fetishism (302.3).

Over the decades, the manual, adapted from a guide for mental diseases developed by Army and Navy psychiatrists, has ballooned. The number of listed disorders tripled to nearly 300. A few have been discredited and dumped along the way. Most famous were battles over the inclusion of homosexuality. Successive iterations of the manual listed homosexuality as a “sociopathic personality disturbance,” then modified that to describe a more limited “sexual orientation disturbance” among people who were “in conflict with” their attraction to people of the same sex. That was later replaced by a disorder called “ego-dystonic homosexuality,” applied to those whose homosexual arousal was a source of distress. That item was dropped in the DSM-III-R, published in 1987.

The great book’s coming edition, the DSM-5, is slated for publication in May 2013. As the task force producing it has posted drafts on its website, an undercurrent of dissatisfaction has exploded into a full-scale revolt by members of U.S. and British psychological and counseling organizations. The chief complaint is that the newest version will lower the criteria needed to diagnose some conditions, creating “subthreshold” disorders, and generally making it easier for healthcare professionals to label a person with a psychiatric disorder and medicate him or her.

The latest rebellion against the DSM-5 began with a salvo from across the Atlantic. In June, a special committee of the British Psychological Society complained in a letter to the APA that “clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences.” The committee criticized the proposed creation of an “attenuated psychosis syndrome”—a sort of poor-man’s psychosis with less severe symptoms—“as an opportunity to stigmatize eccentric people.” They also objected to a proposed reduction in the number of symptoms needed to diagnose adolescents with attention deficit disorder (ADD) because it might increase diagnoses and the use of meds.

Then David Elkins, professor emeritus at Pepperdine University and president of the Society for Humanistic Psychology, a division of the American Psychological Association, formed a committee to discuss similar objections and draft a petition enumerating them. In October, he posted the petition online. “I figured we’d get a couple hundred signatures,’’ Elkins said.

The response stunned him and his colleagues. The petition attracted more than 6,000 signatures in three weeks; as of mid-December it had topped 9,300 signatories and garnered the endorsement of 35 organizations. On Nov. 8, American Counseling Association president Don Locke jumped in with a letter to the APA objecting to the “incomplete or insufficient empirical evidence” underlying the proposed revisions and expressing “uncertainty about the quality and credibility” of the DSM-5.

“This has become a grassroots movement among mental health professionals, who are saying we already have a national problem with overmedication of children and the elderly, and we don’t want to exacerbate that,” says Elkins.

For many critics, Exhibit A is childhood ADD. As the disorder describing fidgety, easily distracted kids morphed from “hyperkinetic reaction of childhood” to the current “attention deficit hyperactivity disorder,” the number of children given the diagnosis exploded, fueling, by one account, a 700 percent increase in the use of Ritalin and other stimulants in the 1990s. Diagnosis requires checking six of nine boxes from a list of symptoms that include “often does not seem to listen when spoken to directly” and “often fidgets with hands or feet or squirms in seat.” Sound familiar, parents?

Two other newly proposed disorders singled out as problematic in the petition are “mild neurocognitive disorder” in the elderly and “disruptive mood dysregulation disorder” in children and adolescents. Both lack a solid basis in research and may fuel the use of powerful antipsychotic medications, which cause weight gain, diabetes and a host of other metabolic problems, the petition says.

“We are gravely concerned that if this is published as is in 2013, it will create false epidemics where hundreds of thousands of children and the elderly who really are normal will be diagnosed with a mental disorder and given powerful psychiatric medications that have dangerous side effects,” Elkins says. “That is not tolerable.”

David Kupfer, the University of Pittsburgh psychiatrist who chairs the task force overseeing the manual’s preparation, says he expects the final number of disorders included in the DSM-5 to be about the same as in the current book. He says he welcomes the criticism and that nothing is final. The task force has been testing proposed new diagnoses in 2,300 patients at seven adult treatment centers and four adolescent centers that are acting as field-test sites, he says.

“There’s a myth that all the decisions have been made, when in fact, all the decisions haven’t been made,” he says. “Just because [things have] been proposed doesn’t necessarily mean they’ll end up in the DSM-5. If they don’t achieve a level of reliability, clinician acceptability, and utility, it’s unlikely they’ll go forward.”

The most surprising critic of the DSM is a one-time pillar of the psychiatric establishment. Allen Frances, professor emeritus at Duke University, chaired the task force that created the DSM-4. Now he’s railing against both the process and proposed content of the new DSM in blogs on the website for Psychology Today that blast the new revision as “untested” and “unscientific.”

Psychiatric diagnoses are loose enough already, Frances  told me, and that laxity has led to “epidemics of over-diagnosis in child psychiatry” causing huge numbers of children to be unnecessarily labeled with attention deficit disorder and bipolar disorder and treated with medications.

“DSM has to be a safe, reliable and credible guide to current clinical practice,” he says. “It can’t be an untested program for future research.’’

The user revolt against the DSM-5 has emerged as a major challenge to the document, Frances says, and its future is looking unclear. He and Elkins are proposing that an independent committee of experts review the proposed draft and make recommendations.

The fight over the DSM-5 pits some of the greatest minds and biggest egos in the world of psychiatry, but it’s more than a battle among 301.81s (narcissistic personality disorder). For people seeking help for life’s problems who don’t want to be labeled mentally ill or have their treatment limited to medication, and for clinicians who want to help people without reducing them to a category, the stakes are high.

http://www.salon.com/2011/12/27/therapists_revolt_against_psychiatrys_bible/singleton/

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Psychiatry bible ‘turns sorrow into sickness’

Saturday, December 3rd, 2011

The Age
By Jill Stark
December 4, 2011

IT’S been branded a “dangerous public experiment” that could turn normal human experiences into an epidemic of mental illness with healthy people being drugged unnecessarily.

In radical changes to the way mental health conditions are diagnosed, what was once considered a child’s temper tantrum could be labelled ”disruptive mood dysregulation disorder”. If a widow grieves for more than a fortnight she might be diagnosed with ”major depressive disorder”.

If a mother in a custody battle tries to turn a child against the father, it might create ”parental alienation disorder”.

These are among new conditions proposed for the fifth edition of the psychiatrist’s bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), due to be finalised next year.

Some doctors in Australia are arguing the revised manual – used globally to diagnose mental disorders – is pathologising unhappiness.

The changes have also caused an international outcry, with the American Counselling Association, American Psychological Association, the British Psychological Society and others calling for the draft of the new edition to be independently reviewed.

They fear it is so inclusive, it risks labelling millions of healthy people as mentally ill.

”It’s such a narrow and limited view of human experience, to want to reduce every bit of suffering to medical diagnosis,” said Jon Jureidini, professor of psychiatry at the University of Adelaide. He said the changes would lead to increased prescribing.

The authors say ”misinformation” about the manual, produced by the American Psychiatric Association since 1952, is creating unnecessary fear and any inclusions will be based on robust scientific evidence. Psychiatrist Ian Hickie, director of Sydney University’s Brain and Mind Research Institute, rejects claims that the new manual would medicalise unhappiness. ”When people are in pain and suffering elsewhere we don’t say people are pathologising that. We say, let’s try and do the best we can to relieve that and get them back to function in the appropriate way,” Professor Hickie said.

The rift reflects division within the mental health community over a global rise in the use of antidepressants, stimulants and antipsychotics, with many clinicians critical of drugs with potentially serious side effects being favoured over more costly talk-based therapies. Others argue that medication can be life-saving where other therapies have failed. The inclusion of conditions such as attention deficit hyperactivity disorder (ADHD) and autism in previous DSM editions is believed to have contributed to increased prescribing.

In the new edition, the diagnosis threshold for some existing disorders is also being lowered so that

over the death of a loved one can qualify as a major depressive illness.

The authors of DSM-5, however, argue that a bereaved person who is suffering from major depression is currently ineligible for that diagnosis, preventing them from getting help if they need it.

”A broad range of evidence … shows that there are little to no systematic differences between individuals who develop a major depression in response to bereavement and in response to other severe stressors – such as being … raped … or the loss of your treasured job,” Dr Kenneth Kendler, a member of the DSM-5 mood disorders group, said.

The changes also mean children only have to display six of 13 possible symptoms for a diagnosis of ADHD, compared with six of nine in the previous manual.

”Under the new criteria it’s almost harder not to get diagnosed with ADHD than it is to get diagnosed with it,” Martin Whitely, a West Australian Labor MP and anti-ADHD medication campaigner, said. ”There were about 60,000 Australian children on ADHD medications in 2010 – a lot of money has gone into marketing and selling the disease.”

One of the manual’s biggest critics is the man who developed the last edition, American psychiatrist Allen Frances. He told The Sunday Age the fact that the authors of the new edition have described it as a ”living document” makes it a ”dangerous public health experiment”.

”The DSM-5 is used in real life-and-death decisions – it shouldn’t be a set of hypotheses to be tested,” he said. ”The worst outcome of this would be all these suggestions get included and a lot of people get medicine they don’t need. But an almost equally bad outcome would be that psychiatry gets so tarred by this aberration that people who really need psychiatry and need the medicine stop taking it.”

http://www.theage.com.au/national/psychiatry-bible-turns-sorrow-into-sickness-20111203-1ocmm.html

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ONE DRUG TO MAKE YOU HAPPY

Monday, November 28th, 2011

NewsWithViews.com – 11/28/2011
by Jonathan Emord, Constitutional Attorney and Author

Psychiatric drugs are big sellers. They are among the best selling drugs made. In 2010, Americans or their insurers doled out some $16.1 billion for anti-psychotics; $11.6 billion for anti-depressants; and $7.2 billion for ADHD treatments.

Within the last two decades the field of psychiatry has mushroomed from a fringe body of Sigmund Freud admirers to a mainstream player in the field of medical pharmacology, largely because of an unseemly union between that profession and the drug industry, leading to the creation of many never before known disease states and profitable ways to exploit those alleged diseases with psychiatric services and drugs.

The field of psychiatry has persistent and well-informed critics who point to the excessive drugging of institutionalized patients, of children commonly misdiagnosed as suffering from Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder, and of the elderly misdiagnosed with treatable dementia, among others. The drugs given these patients have their own side-effects, including increased risk of depression, suicidal thoughts, birth defects, and even death. Because of the movement of psychiatry from the fringe of medicine to its heart, a majority of Americans are likely to come into contact with psychiatric drugs, either recommended for use by their children or for use by them at some point in their lives. Indeed, presently some 1 in 5 adults take anti-depressants, anti-psychotic, or anti-anxiety drugs.

The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5), the profession’s so-called diagnostic bible, will soon be published in 2013. It comntinues the trend of identifying as “diseases” conditions that have previously been considered within the normal range. It adds to the list of “disease” states “apathy syndrome” (i.e., not caring enough); “internet addiction disorder” (i.e., liking the web too much); “parental alienation syndrome” (i.e., not liking your parents enough); “mild neurocognitive disorder” (i.e., age-related decline in mental function); “absexual” disorder (i.e., disliking sex); and “sluggish cognitive tempo” (i.e., daydreaming too much). Characteristics that we all used to think within the realm of normal brain function (such as teenage angst at parental rules; parental angst at teenage rebellion; a loss of quick wittedness in the elderly; youthful exuberance or youthful preoccupation with daydreams beyond the confines of academia) are all fast becoming “diseases.” The APA’s overall movement has been one of calling into question characteristics of eccentricity, leading to an unscientific conclusion that anything different may be rightly called a disease and rightly prescribed a treatment.

Every newly identified psychiatric disorder begets a new slate of psychiatric drugs for their treatment, giving leading pharmaceutical companies new opportunities to profit from the expansion of psychiatric diagnoses.

Psychiatric drugs are big sellers. They are among the best selling drugs made.

In 2010, Americans or their insurers doled out some $16.1 billion for anti-psychotics;

$11.6 billion for anti-depressants;

and $7.2 billion for ADHD treatments.

Profit lies in designing drugs for the treatment of these conditions. As the drug industry continues to pump out new elixirs that, in turn, leads to more reliance on psychologists and psychiatrists, which leads them in turn to prefer identifying more conditions as disease. The perverse incentives abound, and the FDA is pleased to approve the drugs at the behest of the drug company sponsors.
Everyone standing to profit from the sale of these agents wins at the expense of patients.

The drugging of America is an enormous problem, having spill-over effects that include drug addiction and destruction of the family, productivity, even national security. With an ever rising population taking these drugs which alter cognitive function, it becomes ever more apparent that the very fabric of our society, its common commitment to stable family life, self-sacrifice for the greater good, and adherence to laws that protect life, liberty, and property are all imperiled. As the drug industry and psychiatric profession profits enormously with each new declared disease state, there is a loss of free agency in the population, a movement that saps self-control from the individual in favor of control by the medical community over basic life-affecting decisions. Patients become dependent, event addicted, to drugs, and ever more dependent on their medical counselors to cope with life.

Whatever may be said for use of psychiatric drugs in those who cannot function in society, the expansion of those drugs to embrace those who can, including those with virtually any characteristic that exceeds the norm, represents a horrific sacrifice of the very promise of life that lies in those eccentricities. It is particularly horrific to watch beautiful, energetic children with all their great promise become addicted to drugs that alter brain chemistry in ways that yield drug dependency and lessen their perception of and enthusiasm for life and their ability to achieve. A majority of children prescribed anti-depressant and anti-psychotic drugs are wrongly prescribed those drugs, even by accepted psychiatric standards. That misguided course is itself a form of deviant behavior by this profession, calling into question the mental stability of those who would profit off of misdiagnosis and mistreatment.

The psychiatric drugging of America is bearing and will continue to bear for generations to come toxic consequences, whether in the form of the destruction of the family, increases in crime, or decreases in productivity and inventiveness. It’s high time for a rebellion against this drugging for the sake of sanity.

http://www.newswithviews.com/Emord/jonathan220.htm

Jonathan W. Emord is an attorney who practices constitutional and administrative law before the federal courts and agencies. Congressman Ron Paul calls Jonathan “a hero of the health freedom revolution” and says “all freedom-loving Americans are in [his] debt . . . for his courtroom [victories] on behalf of health freedom.” He has defeated the FDA in federal court a remarkable eight times, six on First Amendment grounds, and is the author of Amazon bestsellers The Rise of Tyranny, and Global Censorship of Health Information. He is also the American Justice columnist for U.S.A. Today Magazine. For more info visit Emord.com.

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Psychiatry fighting over what is and what isn’t a mental disorder…again

Thursday, November 17th, 2011
Note from CCHR: We modified the original headline (below) for the sake of accuracy.
Expanding catalog of mental disorders worries some anyone who is rational

Networks – November 16, 2011 by Maiken Scott

The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.

Thousands of mental health professionals who are not happy with the direction of the new DSM are signing an online petition.

The DSM is a highly influential publication—it guides diagnosis, research and policy. The last edition of the manual was published in 1994, meaning this new edition must reflect almost 20 years of new research and treatment advances. The stakes are high, and so is anxiety around changes and additions.

The online petition posted by several professional organizations for psychologists criticizes those working on the new DSM for what they call “lowering diagnostic thresholds.”

Philadelphia psychologist Cindy Baum-Baicker, who has signed the petition, said the number of different mental health diagnoses is growing too quickly.

“We already have 297 diagnoses. When we started the DSM, we had 106,” she said. “We’re going to have even more.”

She is concerned about several specific aspects of the new DSM, for example changes that could turn prolonged grieving into a diagnosis. Grief, she said, is a natural and important part of life.

“If we pathologize the sadness of grief, and we put people on medicine so that they don’t experience their sadness and feel it through, they oftentimes aren’t going to be making the changes they need to be making to get on with life,” Baum-Baicker said.

University of Pennsylvania psychology professor Marna Barrett has not signed the petition—even though she shares some of the concerns it addresses.

She said the professionals working on the DSM have been receptive to feedback—which she says is a good thing, but can also cause difficulties.

“In no other aspect of medicine do we have a handbook of disorders where the public can put their two cents in as to what is a disorder or not, where colleagues can say this is a disorder or not,” Barrett said.

Barrett said decisions about the DSM should be firmly based in evidence and research and not yield to social and political pressures, or lobbying efforts from interest groups such as advocacy organizations headed by parents or consumers.

The online petition criticizing the DSM has collected more than 6,000 signatures so far.

 

 

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Those in favor of Psychiatry’s Billing Bible? The American Psychiatric Association. Against it? Just About Everyone else

Thursday, November 3rd, 2011

Click image to watch video (explaining in simple terms, what the “problem” with psychiatry is….)

Psychology Today – November 1, 2011

by Allen Frances, MD (Psychiatrist and former Chairman of the DSM task force)

So far, opposition to DSM 5 has been expressed by the following organizations: British Psychological Society; American Counseling Association; Society for Humanistic Psychology (APA Division 32); Society for Community Research and Action: Division of Community Psychology (APA Division 27); Society for Group Psychology & Psychotherapy (APA Division 49); Developmental Psychology (APA Division 7); UK Council for Psychotherapy; Association for Women in Psychology; Constructivist Psychology Network; Society for Descriptive Psychology; and the Society of Indian Psychologists.

An editorial by the Society Of Biological Psychiatrywondered whether DSM 5 was necessary at all. The community of personality disordersresearchers is virtually unanimous in its opposition to the DSM 5 personality disorders section. There has also been widespread opposition to the sections on somatic, autistic, gender, paraphilic, and psychotic disorders.

Last week, a petition was posted quietly be several divisions of the American Psychological Association. It demands reform of the DSM 5 process and the elimination of a number of its most risky and ill conceived proposals. The petition is gaining increasing support and has already been signed by almost 3000 people. It can be accessed at http://www.ipetitions.com/petition/dsm5/ )

Strikingly, there seems to be virtually no support for DSM 5 outside the very narrow circle of the several hundred experts who have created it and the leadership of the American Psychiatric Association (APA) which stands to reap large profits from its publication. There is no group and precious few individuals outside of APA who have anything good to say about DSM 5. And even within the DSM 5 work groups and the APA governance structures, there is widespread discontent with the process and considerable disagreement about the product.

http://www.psychologytoday.com/blog/dsm5-in-distress/201111/dsm-5-against-everyone-else

 

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Was Sybil a psychiatrist’s creation?

Thursday, October 20th, 2011

New Scientist
By Samantha Murphy
October 20, 2011

It is the tale that launched a thousand alter egos: the famous true story of “Sybil”, who endured years of torture at the hands of her sadistic mother and grew up into the meek, anxiety-ridden adult whose head was said to house 16 personalities.

For many, she provided a startling introduction to a rare and intriguing condition: then known as multiple personality disorder (MPD), a disease of the mind affecting mostly women, in which a person hosts several vastly different personalities representing fractured aspects of a haunted past.

Luckily, with the help of her psychiatrist’s enduring dedication to her treatment – which included many punched-out office windows and late-night house calls – Sybil was finally able to come to terms with the other sides of herself and integrate them, triumphing over her disease. The tale made for a compelling book, Broadway show and an even more engaging movie in 1976 (and a less riveting remake in 2007). The book and film became instant classics, not to mention teaching tools for psychology students.

But according to investigative journalist Debbie Nathan, the story of Sybil has one big problem: it’s mostly bunk.

In Sybil Exposed, Nathan, famous for her exposés on “recovered memory syndrome”, goes through the story, claim by claim, with a fine-toothed comb. It’s a massive undertaking of research that teases apart fact from fiction to reveal an even more interesting and educational account of, not 16, but just three personalities: the author, Flora Schreiber, the psychiatrist, Cornelia Wilbur, and “Sybil”, Shirley Mason.

What Nathan found among the archives was “shocking but utterly absorbing”, she says. Mason’s 16 personalities had not appeared spontaneously as they do in the book and movie, but were “provoked over many years of rogue treatment that violated practically every ethical standard of practice for mental health practitioners”, she writes.

This is quite a firebomb to throw into a heated battle that started in the late 1990s and is still being fought today. The lines are drawn between whether MPD, since renamed dissociative identity disorder, exists as an artefact of post-traumatic stress disorder, as its own unique illness, or if it is merely the product of wishful, reinforcing therapy and willing clientele.

While the next edition of psychiatry’s bible, the Diagnostic and Statistical Manual of Mental Disorders, is in development, this is no small quibble.

Nathan uses direct quotes from the actual psychoanalysis session transcripts, excerpts from Mason’s diaries, and Schreiber’s author notes to provide fascinating insights into how these three women turned sickness and desire into a business.

When Wilbur, an ambitious female psychiatrist in a field packed with men, found Mason, an attention-starved and admiring patient, it was not long before they were engaged in a twisted parent-child kind of relationship. Nathan shows how Wilbur supplied her patient with attention and affection, and Mason eagerly performed whatever dance seemed to please Wilbur most.

At one point Mason wrote a letter attempting to confess to Wilbur that she had invented these personalities. She also asked that they stop “demonizing” her mother – who Wilbur had cast as a vicious abuser but who Nathan suggests was just religiously strict and emotionally unpredictable. Wilbur dismissed the letter as a defence mechanism, and her patient, desperate not to lose the doctor’s interest, continued the charade. Soon after, the two women met Schreiber, who spun their story into the profitable and sexy legend we know today.

Sybil remains a good book and movie, but perhaps Nathan’s version of the story is the one worth telling in classrooms. Though it is the less sensational tale, it is a cautionary one. It is a solemn reminder of why mistrust plagues the mental health field, and why we must always be careful to pin down the facts, and leave it to fiction to get carried away with the story.

http://www.newscientist.com/blogs/culturelab/2011/10/was-sybil-a-psychiatrists-creation.html

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If I have mental illness, I want doctors to prove it

Wednesday, October 12th, 2011

The Irish Times, October 11, 2011
by John McCarthy

Click on image to read the Mental Health Declaration of Human Rights

I AM MAD, a proud member of the mad community. Of course, madness exists – it’s normal, it’s as old as mankind, and it’s in every family. But if I have a disease in my brain called “mental illness”, I want the doctors to prove it. The brain is the most complicated organ in the body, yet doctors diagnose mental illness just by looking at you, and then you are labelled for life.

I’ve been diagnosed with unipolar depression, bipolar or manic depression, dysphoric elation – whatever that’s supposed to be – and paranoia. I’ve been told that I have a chemical imbalance in my brain that shows I have a mental illness. Yet not one of these fellows even took my pulse. They did it by sitting looking at me and talking to me.

I had a breakdown as a consequence of my dysfunctional childhood and because my business was collapsing – the banks were hounding me and I owed thousands. I was locked up for a year. I attempted suicide when I was on my heaviest dose of medication – a mixture of 10 different drugs a day.

There’s no such thing as a sudden breakdown: the madness was like the San Andreas Fault within me, lying dormant and buried. It was like an emotional stroke, a stroke of the spirit rather than the brain. But stroke victims can recover and they aren’t permanently labelled as disabled.

Our mental health laws allow two psychiatrists to sign a piece of paper and lock you up for the rest of your life because you’ve been diagnosed with a mental health problem. It’s based on nothing more than opinion, and that’s part of the cruelty of the mental health system in this country. You can be incarcerated and force treated against your will.

Why try to define madness? We should stop defining. We are all individuals with individual lives, and people react differently to different life situations. But the pharmaceutical industry, working with psychiatrists, tries to mass treat the individual, putting everyone in the same box.

Of course, madness has a downside. I hated it, but my hate was for myself really. I lost the ability to receive love. I was a complete pain in the arse, but my wife and family never stopped loving me. Yet you can learn from being mad. In fact, it was one of the most constructive learning experiences of my life.

I learned how to receive love with confidence. I have learned how to be at peace with who I am.

How do you learn to receive love? Well, if someone says you look well today, you say thank you. That’s the first step, but when I was in my negative side, that felt as hard as climbing Everest.

The Murphy and Ryan reports quite clearly showed that when you give power and authority to one section of the community over another abuse is bound to follow.

Mad Pride Ireland brings out the stories of people who have been abused under this system.

Society has bought into this idea that the mad community is dangerous and to be feared. The nuns got away with the same kind of thing for years with “loose women”; they took the problem part of the community away and buried them.

But we need to be free to ask awkward questions, to challenge the ethos of power and control. There is an aura of fear around psychiatric units. If you’re hopeless and helpless, you’ll be embraced and looked after. If you start asking questions, if you speak out with strength, they don’t want to know. When I started questioning things, I was offered more medication and told I was developing paranoia.

With every Mad Pride event we open up a public playground; there are no protests, no speeches. We scan everyone for normality – clowns use rubber chicken “normality detectors” to check people for signs of normality – and no-one has passed that test yet. We had 17,000 people at our event in Cork, all rocking to the music on a beautiful summer’s day.

It’s all about showing that madness is an everyday occurrence that affects everyone, and it can be dealt with in an open, loving way, with no fear. Now key people are beginning to listen to us. It shows what you can do with no money but a bit of goodwill.

Today I am lying here with motor neurone disease. I prefer the old name for it – creeping paralysis. You lose the use of your limbs, the ability to swallow, you end up incontinent. It’s a relentless disease. But there’s an honesty about the way neurology approaches it. Neurologists admit they don’t know the cause or cure for it.

They have done every test under the sun, I’ve undergone the deepest brain scan imaging in the country. But they admit they don’t know where it comes from and there is no fix, no treatment. Yet a psychiatrist can diagnose you just by looking at you.

I am happy for the psychiatric diagnoses I have had to be scientifically tested. I have a suggestion: I will put myself forward for psychiatrists to carry out any test they wish to do, in public, and I will publish the results. I’m dying, so I have nothing to lose.

click image to read more

But no-one is ever going to get a diagnosis of mental illness out of science: you will only ever get a diagnosis based on an assessment of behaviour. There is no science behind this disease, yet we have given the power of law to this guesswork. How are they getting away with this?

http://www.irishtimes.com/newspaper/health/2011/1011/1224305573629.html

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