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.
Proposed updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM) are prompting many to question whether or not the psychiatric profession itself has gone crazy. The latest additions to the alleged “mentally ill” could include hoarders, people who get angry every now and again, lazy people, and even those who get outraged over things like sex and violence on television.
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.
First the good news: The Physician Payment Sunshine Act is now law, signed by President Obama as part of the health care bill overhaul. Starting in 2012, drug and medical device companies must report all consulting, speaking and other payments to doctors and teaching hospitals in excess of $100 annually to the federal Department of Health and Human Services, which will post the payments on a public website. This is an important first step toward making transparent the pervasive financial ties between doctors who are studying or promoting specific drugs and medical devices and the companies that manufacture these products.