Fox News – February 21, 2012
By Dr. Keith Ablow
The American Psychiatric Association (APA) is in danger of losing the little credibility it still enjoys.
The organization is chasing medical insurance company reimbursement money by empowering “working groups” to invent whole new diagnoses by committee.
This is bad form for an association of professionals whose life work is supposed to be pursuit of the truth. And it comes at the worst time: When Americans have about had it with ploys to pump up revenues and profit from the public till.
According to sources familiar with the content of the official Diagnostic and Statistical Manual V—under development by the APA and slated for publication this year—people who are grieving and people who are shy will be labeled with “disorders.” So, too, will some people who rape children or adults. Hoarders—who, heretofore, might have qualified for obsessive-compulsive disorder—may get their own special diagnosis, too.
Hey, why not? There’s a reality TV show about that. Why not a diagnostic code, too?
Meanwhile, conditions which psychiatrists are used to diagnosing—like schizoaffective disorder and gender identity disorder, may be phased out. Those seem to have been unpopular, I guess. Bipolar disorder, which has been considered a mood disorder, could be reclassified as a psychotic disorder.
All in all, more human beings struggling with their emotions will be classified as sick, leading to more diagnostic codes that fit their supposed “disorders” and more money billed to Medicare, Medicaid and private insurers.
This unhealthy contamination of science by economics has a long tradition at the American Psychiatric Association. The whole idea of promulgating more and more diagnoses, with codes like 300.23 and 309.81 and 307.44, Recurrent, was always partly a scheme to wrench the rich tradition of understanding and healing people’s psyches into the dictates of medical model billing. It also fits neatly with the Continuing Medical Education monies routed to the APA by pharmaceutical companies whose medicines get FDA indications for particular diagnoses.
The more diagnoses, the better. Everyone gets one. Everyone gets billed. Everyone leaves with a prescription.
The only trouble is that, under this system, the high art of empathy and life story analysis has been left to wither from disuse, like a beggar outside a bazaar.
What other medical specialty arrives at an official list of diagnoses by committee, then creates a bestselling book with the resulting codes (that nets the APA untold millions)? Can you imagine groups of endocrinologists getting together to coin terms like “Excessive Urination Disorder of High Blood Sugar, With Attendant Social Disruption?” How about cardiologists coming up with “Pain Over Sternum Associated with High Fat Diet, Despite Adequate Exercise?”
Not only does the APA translate science into the nomenclature of medical billing, but it also plays political/cultural favorites with its diagnostic manual. When it became unfashionable and politically risky to offer help to people who were unhappy with their sexual impulses and wanted to change them, the APA yanked ego-dystonic homosexuality from its manual. That meant that people who were drawn to same-gender partners and didn’t want to be didn’t have a place in the official healing tent of psychiatry, anymore.
I object to a medical specialty playing it so loose with both science and the human spirit. And since it happens to be my medical specialty, I take special offense.
I am reminded of one of my mentors, the great psychiatrist Dr. Edward Shapiro. One day, when my fellow residents and I were chatting with one another, letting Shapiro sit there and wait for us to quiet down, we noticed that his eyes were filling up. Slowly, the room grew utterly silent. Shapiro took off his glasses, looked at each of us, in turn, then said, “In case you miss it, I love this work. And when people show it no respect, it tears me apart.”
The thought of such a man as this being made to conform to a fictional manual of mental disorders should be enough to make the President of the APA delay publication of the DSM V and rethink where the organization is headed—and why.
Dr. Ablow is the author of “Inside the Mind of Casey Anthony.” He is a psychiatrist and member of the Fox News Medical A-Team.
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