The arguments against DSM-5 are really quite simple and straightforward — and to me seem absolutely compelling. DSM-5 has failed to allow an open, independent and rigorous scientific review of the evidence supporting its suggestions. It is the result of a secretive and closed process that has lost touch with clinical reality. Its suggestions for new diagnoses and for reducing thresholds on old ones will promote a radical explosion in the rates of psychiatric diagnosis that will worsen our country’s already excessive use of medication. Finally, the DSM-5 preoccupation with diagnosing disorders in people who are not really ill will result in a misallocation of resources that disadvantages those most clearly in need them.
The drugging of children for A.D.H.D. has become an epidemic. More than 5 million U.S. children, or 9.5 percent, were diagnosed with A.D.H.D. as of 2007. About 2.8 million had received a prescription for a stimulant medication in 2008.
The A.D.H.D. diagnosis does not identify a genuine biological or psychological disorder. The diagnosis, from the 2000 edition of the “Diagnostic and Statistical Manual of Mental Disorders,” is simply a list of behaviors that require attention in a classroom: hyperactivity (“fidgets,” “leaves seat,” “talks excessively”); impulsivity (“blurts out answers,” “interrupts”); and inattention (“careless mistakes,” “easily distractible,” “forgetful”). These are the spontaneous behaviors of normal children. When these behaviors become age-inappropriate, excessive or disruptive, the potential causes are limitless, including: boredom, poor teaching, inconsistent discipline at home, tiredness and underlying physical illness. Children who are suffering from bullying, abuse or stress may also display these behaviors in excess. By making an A.D.H.D. diagnosis, we ignore and stop looking for what is really going on with the child. A.D.H.D. is almost always either Teacher Attention Disorder (TAD) or Parent Attention Disorder (PAD). These children need the adults in their lives to give them improved attention.
A highly effective public relations technique is the “third party technique” of creating front groups to endorse or promote the need of any service or product. The first party is the original group or client that would benefit more from increased public trust or affinity. The second group is the public or consumers. A third group is created with a contrived name to appear publicly as a disinterested party endorsing the industry of the first party.
Often, the third party, or front group, uses a name that implies authority or concern for the public’s welfare or concerns. You can be sure these bogus front groups are usually only concerned about their clients welfare and themselves.
I never would have entered the DSM-5 controversy were it not for two of its proposals that risk furthering the already frightening overuse of antipsychotic medication, particularly in children and teenagers. DSM-5 plans to introduce two new and untested diagnoses that would offer natural targets for poor drug prescribing–psychosis risk syndrome (AKA attenuated psychotic symptoms) and temper dysregulation (AKA disruptive mood dysregulation). There is no evidence whatever that antipsychotics would confer any benefit on the kids so labeled (and too often mislabeled), but great reason to worry that this would not stop their being used needlessly and recklessly.
For any mental illness or passing mood swing that may trouble a person, the Diagnostic and Statistical Manual of Mental Disorders — better known as the DSM — has a label and a code. Recurring bad dreams? That may be a Nightmare Disorder, or 307.47. Narcolepsy uses the same digits in a different order: 347.00. Fancy feather ticklers? That sounds like Fetishism, or 302.81. Then there’s the ultimate catch-all for vague sadness or uneasiness, General Anxiety Disorder, or 300.02. That’s a label almost everyone can lay claim to.Drug companies are particularly eager to win over faculty psychiatrists at prestigious academic medical centers. Called “key opinion leaders” (KOLs) by the industry, these are the people who through their writing and teaching influence how mental illness will be diagnosed and treated. They also publish much of the clinical research on drugs and, most importantly, largely determine the content of the DSM. In a sense, they are the best sales force the industry could have, and are worth every cent spent on them. Of the 170 contributors to the current version of the DSM (the DSM-IV-TR), almost all of whom would be described as KOLs, ninety-five had financial ties to drug companies, including all of the contributors to the sections on mood disorders and schizophrenia.