Thursday, February 28, 2013

DSM-5 and the Sorry State of American Psychiatry

If you think I've been underproducing blog posts lately, you can lay the blame at the doorstep of Rick Bukata and Jerry Hoffman of Primary Care Medical Abstracts. Being a lazy cuss, I often don't know that an article of interest has been published until they include it in their monthly literature updates, and their January edition was quite late in coming out. But when it arrived it did include two papers that shed a bright light on a topic we've addressed in the past, such as:

The first article is an opinion piece that fires a broadside at the new DSM-5 and the "psychiatric oligarchs" who wrote it:

Scottish GP Des Spence notes the new CDC figures showing that based on the expansive way we now define mental illness, about a quarter of the US population is mentally ill. Now, if a group had a tiny sliver of scientific curiosity, this statistic would be a matter of dismay and demand immediate and thorough study--either something horrible has been added to the US water supply, or else the way mental illness is defined and counted has become totally disconnected from any form of medical reality. Yet the psychiatric community can apparently look on these figures with satisfaction.

Spence lays the blame clearly at the feet of conflict of interest, noting that 75% of the authors of DSM-5 are awash in COI. Spence avers that the new, broader definitions of mental illness in DSM-5 "defy common sense and will serve only to undermine psychiatry’s professional standing. It is yet more industrial mass production psychiatry to serve the drug industry, for which mental ill health is the profit nirvana of lifelong multiple medications."

By way of illustrating what this means, we can turn to the second article:;jsessionid=40498050C908CBC4C63E2D01A0C0B731.d03t03

Dr. Herschel Jick and colleagues from Boston University looked at how methylphenidate (Ritalin) was prescribed for children aged 5-14 in the US vs. Britain. They found out by the way that equivalent supplies of the drug cost about 4 times more in Britain than here. But much more worrisome is the evidence that more than 4 times as many kids in the US were being prescribed this drug, supposedly for attention deficit disorder, than is true in the UK. It seems that our threshold for deciding a kid has a major mental disorder, with all the implications of carrying that label for life, is much lower than it ought to be. And Spence for his part notes that in the new DSM-5 the criteria for diagnosing ADHD are loosened substantially.

I'll go back to my previous post on Robert Whitaker's important book--
--as well as to my previous post on the antipsychiatry movement:
--to remind anyone just joining us that I have not joined the scientologist crazies and that I agree with Whitaker that there is a group of folks (he estimates about a fifth of those now taking psychiatric medications in the US) who suffer miserably without their meds and who are vastly more functional with them. But when we decide that a quarter of the US population is mentally ill and probably ought to be on drugs, then what used to be a thoughtful and helpful medical specialty seems to have turned into nothing more than a marketing agency for Big Pharma.

What to do? There is probably a simple step that could well be effective. We usually figure that a medical specialty group can be trusted to tell us how to diagnose conditions that fall within their specialty. So, for instance, if cancer specialists tell us that such-and-such is what make a cancer of the prostate Stage 2, then other specialists use those criteria and the Stage 2 label for that form of disease. So it has been logical that other specialties that treat patients with mental illnesses, such as family physicians, pediatricians, internists, etc., have routinely used the DSM's earlier editions as their guide to diagnosing and labeling mental illness.

Therefore, the American Academy of Family Physicians, the American College of Physicians, and all other specialty groups ought to declare officially that they reject DSM-5 and will advise their members not to employ its terminology or criteria. Unless and until the American Psychiatric Association can come up with a scientifically more valid manual created by people free of conflicts of interest, they should not be able to foist their commercial product (off which they make huges sums in sales) on the wider medical community.


Bernard Carroll said...

Does American psychiatry matter?

Does the American Psychiatric Association have a death wish?

parental unit said...

If it's not stopped early, it will be perpetuated by precedent and the authority of the printed word. This is no period in the history of psychiatry to enshrine anything. Its framers claim that they are bringing psychiatry into the mainstream of medicine - mainstream science fiction is more like it.

parental unit said...

If it's not stopped early, it will be perpetuated by precedent and the authority of the printed word. This is no period in the history of psychiatry to enshrine anything. Its framers claim that they are bringing psychiatry into the mainstream of medicine - mainstream science fiction is more like it.

Anonymous said...

Few travellers on a Mashobra tour can resist the temptation of seeking blessings
at the Mahasu Devta Temple. There is an opportunity for parents to offset the teacher: pupil ratio through practice at home.
If you have ever tried to kid yourself that everything will be fine
and glossed over certain issues because you wanted
to avoid them, or did not know how to deal with them.
Fun the first time, but just not enjoyable after numerous journeys.
Their history timeline details how the greenhouse covered 4,000 square feet, and in 1976, a 6,000 square foot greenhouse was added.
"What have you Googled lately. We actually become happier people. Most visitors on a trip to Munnar invariably end up at the Tata Tea Museum and gain some delightful insights into the process of tea making. * You're realistic about what you expect from others. For people from non technical background these things look like rocket science.

my blog ::

Anonymous said...

Dr. Brodie,

I seriously doubt any physicians' groups will reject the DSM5 as sadly, is easier for them to hand out a psych med prescription vs. trying to solve the patient's underlying problem. That definitely happened to me and was quite traumatic to be honest as I felt bullied in being pressure to take unwanted psych meds. The experience has caused me to be quite leery in trusting any doctor.