This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.
This is a crucial issue. As the Saybrook psychology faculty note in their remarkable blog “The New Existentialists:” “the DSM-5 inflates diagnostic criteria to such an extent that it pathologizes normal behavior and natural human functioning.”
Under this new “Bible of Psychiatry” every aspect of human life, every thought and feeling, can be considered a form of “mental illness” and treated with drugs. An egregious example is a proposed change that would make any depression about the death of a loved one that lasts longer than two months a mental illness treatable by anti-depressants.
This is madness. Millions of people who are perfectly healthy, who are not sick but are looking for help, will be forcibly turned into customers for the pharmaceutical industry. Psychologists are being encouraged to spend less and less time actually talking with those they are seeking to help, getting to know them as human beings, and taking their search for meaning in life seriously.
As the news tumbled out last week that the American Psychiatric Association had hired GYMR, an expensive PR company, to help the organization “execute strategies that include image and alliance building, public education campaigns or media relations to harness the formidable forces of Washington and produce successful results for clients” (services that GYMR brags about in its mission statement), it became clearer than ever that the APA has more than an image-problem with DSM-5.
With The Lancet, New England Journal of Medicine, 51 professional organizations, a sizable blogging community, and the manual’s former editor, Allen Frances, all voicing strenuous concern about the manual’s planned revisions and likely content, the hiring of a PR firm to “execute … image-building”—that is, to gloss over serious diagnostic issues and controversies in psychiatry—amounts to a fig leaf, a frantic effort to whitewash the manual’s many flaws and questionable content.
EFFORTS to update the psychiatrists’ bible – the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – have led to bickering, contention, organised revolt and, finally, a backdown.
The association announced it has abandoned plans to class so-called attenuated psychosis syndrome and internet addiction as psychiatric disorders.
And four disputed additional criteria for diagnosing attention deficit hyperactivity disorder (ADHD) have been dumped: “impatience”, “acting without thinking”, “uncomfortable doing things slowly and systematically” and “finds it difficult to resist temptations or opportunities”.
“LABEL jars, not people” and “stop medicalising the normal symptoms of life” read placards, as hundreds of protesters – including former patients, academics and doctors – gathered to lobby the American Psychiatric Association’s (APA) annual meeting.
The demonstration aimed to highlight the harm the protesters believe psychiatry is perpetrating in the name of healing. One concern is that while psychiatric medications are more widely prescribed than almost any drugs in history, they often don’t work well and have debilitating side effects. Psychiatry also professes to respect human rights, while regularly treating people against their will. Finally, psychiatry keeps expanding its list of disorders without solid scientific justification.