Some time back I remarked on a new childhood “affliction” to be dealt with by the judicious use of drugs and psychiatrists: “Oppositional Defiant Disorder.” If you had four or more of the following as a child, you were ODD, and I guess I was, too…
Two Jews may, as the saying goes, have three opinions, but that appears to be a fairly modest ratio when compared with psychiatrists. It was inevitable that revisions to the Diagnostic and Statistical Manual of Mental Disorders would invite controversy—it’s the classic reference work for mental-health professionals, and a convenient field guide to understanding crazy exes for the rest of us—but even the American Psychiatric Association, which first appointed the work groups to update the text two years ago, couldn’t have predicted the squabbles now under way.
DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift”. Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system – stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.
Since his appointment as Australian of the Year, Professor Patrick McGorry has established a prominent profile in the media, calling for major mental health reform. It is clear that many people, including the Federal Government, are listening to him…. Under McGorry’s proposed reform, large numbers of “false positives” – young Australians – would be caught by the wide early intervention net and exposed to serious risks from drugs that have not been proven to be effective.
Among all the problematic suggestions for DSM5, the proposal for a ” Psychosis Risk Syndrome” stands out as the most ill conceived and potentially harmful. It aims to solve a pressing problem in psychiatry- the need for early identification and preventive treatment. Psychotic episodes create tremendous short term impairment and may impact negatively on long term prognosis and treatment efficacy. It would save great suffering if we could get there early and do something useful to reduce the lifetime burden of illness before too much damage is done. But good intentions are not enough.