DSM

A new edition of the most widely used psychiatric guide to mental disorders — “The Diagnostic and Statistical Manual of Mental Disorders” — was released this past weekend in San Francisco at a meeting of the American Psychiatric Association. The manual has a big impact on public health, including what insurance companies will cover, the drugs that regulators will approve, and even which children will receive special education services. But critics say that the manual is outdated and question the validity of several new diagnoses.

Guests:
Mardi Horowitz, professor of psychiatry at UCSF, president of the San Francisco Center for Psychoanalysis, and author of "Grieving As Well As Possible"
Allen J. Frances M.D., chair of the DSM-IV Task Force and professor emeritus and former chair of the Psychiatry Department at Duke University; and author of "Saving Normal" and "Essentials of Psychiatric Diagnosis"
Dr. Jeffrey Lieberman, Lawrence C. Kolb Professor and chairman of psychiatry at the Columbia University College of Physicians and Surgeons, and director of the New York State Psychiatric Institute; he is also the president-elect of the American Psychiatric Association

  • Guest

    If anyone who questions authority is now defined as being insane, as this new DSM reportedly says, then truly the USA has become a police state, because that it what they were saying back in Nazi Germany before sending dissidents off to be jailed or killed, or in Stalin’s Russia before sending them off to the gulags. Thugs are very predictable in this way. “You don’t like today’s punishment? You don’t like my hypocrisy? OK you’re crazy. Off you go.”

  • Candidus

    If anyone who questions authority is now defined as being insane, as this new DSM reportedly says, then truly the USA has become a pólice state, because that it what they were saying back in Názi Germany before sending dissidents off to be jailed or killed, or in Stalin’s Russia before sending them off to the gulags.
    Thugs are very predictable in this way. “You don’t like today’s
    punishment? You don’t like my hypocrisy? OK you’re crazy. Off you go.” And what a surprise, that the psychological establishment might kowtow to the powers that be and redefine dissent as crazy.

  • Beth Grant DeRoos

    This is an excellent example of doctors playing God. Do these mortal humans have ANY idea the havoc they are creating in so many peoples lives.

    The joke used to be that the pharmaceutical companies had the motto ‘create a need and fill it’. Seems the American Psychiatric Association has taken that as their motto as well.

    Read the book Eccentrics A Study in Sanity and Strangeness by David Weeks who notes here in the states we lock up or medical our eccentrics.

    Also recommend this article Why French Kids Don’t Have ADHD
    http://www.psychologytoday.com/blog/suffer-the-children/201203/why-french-kids-dont-have-adhd

    • thucy

      Beth,

      Thanks for the links, I’m eager to read them. You might also be interested in this interview re DSM with Gary Greenberg on WNYC:

      http://www.wnyc.org/shows/bl/2013/may/03/dsm-woes/

      • Beth Grant DeRoos

        Thucy thank you for the link. That was a good show. Had heard of the book Manufacturing Depression but have never read it, but will now.

  • La différence entre nous

    How about having a guest on who can provide the French perspective, since they do not use the DSM?

    • Beth Grant DeRoos

      Its why I noted in a comment that I also recommend this article Why French Kids Don’t Have ADHD
      http://www.psychologytoday.com

  • guest

    Personality disorders continue to be assigned to females who speak out [ http://www.mysanantonio.com/twice-betrayed/ ] and what is referred to as “complex” post-traumatic stress, which effects more females than males, continues to remain untreated because the drafters of all versions have been primarily “white male psychiatrists who embedded the documents with their biases.”*

    [ *Beutler, L and Malik, M. Rethinking the DSM: A Psychological Perspective. Washington, DC: American Psychological Association, 2002, p. 6. http://psycnet.apa.org/psycinfo/2002-02349-000 ]

  • thucy

    Corrupt psychiatrists? This is all so Harvey Korman as Dr. Montague in Mel Brooks’ “High Anxiety”…

  • thucy

    Guest use of term “stakeholders” instead of practitioners is an interesting Freudian slip.

    • It’s not a Freudian slip–“stakeholders” is a more inclusive term which includes doctors, therapists, patients, family members an caregivers, and pharma.

      • thucy

        “…and pharma”.
        Thanks, Rachel. Let’s never forget the honorable contributions of “pharma”!

        Does the use of stakeholder in that “more inclusive” sense come out of the psychiatric field or social work field? Or PhRMA? Given the other definitions of the word stakeholder, it’s semantically… challenged. OTOH, given Dr. Marcia Angell’s coverage of how poor children are being disproportionately psych-diagnosed and medicated so parents can collect SSI to keep a roof over their heads… maybe it’s dementedly appropriate. What a mess.

  • thucy

    this is really funny – first guest (Dr. Jeff Lieberman?) is discussing EVERYTHING EXCEPT DSM-V, and host can’t steer conversation.

    • mic

      The initial guest advocate never cited a psychological condition. Everything was physical maladies. Thanks thucy!

    • Beth Grant DeRoos

      It’s days like this I miss Michael Krasny SO much.

      • mic

        The problem is that Michael Krasny would be hard pressed to criticize this gaggle of New York Jewish shrinks. He would be taken off the air if he were to ask hard questions,–better to send a quisling into the fray and take a day off !!

  • thucy

    KQED: Please update web page with names of guests – Horowitz only name listed.

  • thucy

    Dr. Marcia Angell in NYRB states that large numbers of poor children are being given psychotropic meds so families can receive SSI to survive.
    This is our social safety net?!!!

  • mic

    Anyone want to comment on Drapetomania (Runaway Slave Syndrome) defined as the inability to accept submission to one’s master in 1851 ? This is the essence of the opposition to this shopping guide for labeling which is the “DSM IV”. It is a blueprint to be assured that anyone anywhere can be picked up by the Black Maria’s. This dangerous pseudo-manual is also used by paraprofessionals, lay persons, and police agencies to incarcerate people who are just exercising their human rights.

  • thucy

    Dr. Angell on PhRMA’s role in DSM:
    “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.’

  • Christine Kiessling Wolf

    The guest just noted factors about lacks in an environment (housing, traumatic environments, etc), yet why aren’t we looking to social justice instead of rolling it all together for a clinician to address “contributing factors” for a mental illness designation? How much are we also pathologizing poverty and being victimized by injustice?

  • April

    Our school child psychologist has diagnosed our 7 year old with Asperger’s after only one observation. The district requires a diagnosis to allow any “special education” adaptations for a student. There is nothing to suggest that my son has Asperger’s. The only issue that he is having at school is poor handwriting. I think over-diagnosing is completely out of hand!

    • mic

      Agreed, and once diagnosed as a seven year old it follows you for life and becomes part of your permanent record.

      • MaineCoon

        And there goes your credibility in anything you think, say or do. The ultimate dehumanization.

  • Eva Lomeli

    As a Licensed Clinical Social Worker who recently helped develop a pilot project in collaboration with the department of Mental Health and Adult Protective Services in Santa Clara County, I witnessed firsthand how many Individuals are living in severely detrimental conditions due to a pathological hoarding condition.

    Most of the Individuals referred to APS are repeat referrals. In general, Individuals with a pathological hoarding condition do not recognize they have a problem; therefore they do not seek treatment. They end up at APS when they are reported due to onset of an eviction process with risk of homelessness or related high health risks.

    Since we do not see many of these Individuals in our mental health clinics, and there had been no formal diagnosis for this condition, a general response has been, “there is not much we can do”.

    There are too many Individuals suffering and at great risk of falls, injury and illness, not to mention complete social isolation due to hoarding. My hope is that as a result of including hoarding as a DSM-V diagnosis, there will be increased efforts in the mental health treatment community to do outreach and help treat these
    individuals.

    • mic

      You would have been amazed at the degree of hoarding during the Great Depression. People are economically insecure no matter whether they are hoarding newspapers to create housing or whether they hoard billions because they are afraid of being poor.

      You go with what you got girl!!

    • MaineCoon

      In accord with mic’s comment below, instead of branding such persons with a poisonous diagnostic label, how about working to get general therapeutic services covered, so that they are available for persons to target whatever specific behavioral issues they are dealing with?
      That psychiatric label brands a person for life (and beyond), as surely as livestock are branded.

      • Eva Lomeli

        MainCoon, the posts I am reading on this thread and your comment about “poisonous diagnostic label” point to the high level of stigma thatcontinures to exist in our society…undersandably so. My hope and advocacy is that there continue to be work inthe area of education, support, and reducing stigma which is a barrier for many indiciduals to accept or seek sometimes much needed treatment.
        The issue og using a diagnosis is not for the purpose of labeling, althought it’s true that it happens and with potential negative consequences. Diagnosing serves the purpose of having a general consensus on synmptom criteria that identify a particular mental health illness formthe purpose of creating a consensus on treatment approaches; both medication and therapy and for billing/ insurance coverage purposes.
        When I mention my experience with Individuals who have a severe problem with hoarding, I’m talking about seniors or adults who can not access their own bathroom or kithen because the floors, hallways are full tomthe ceiling with “things”. Without pathways to WB for example, I have witnessed homes full of feces or other rotting things and Individuals who completely isolate themselves socially because they dont want others to see their living conditions.
        I work for a goverment county clinic and I do not advocate for increased treatment for purpose of gaining more Consumers (we hace too many already) i advocate for treatment because Individuals with mental health conditions are suffering greatly. Insurance companies, the State, and Federal goverment will not reimburse for treatment for Individuals that do not meet the severity criteria established in a DSM diagnosis. Therefore although I agree that many of the concers expressed regarding labels and how these could be misused by Individials (to access dissability benefits), pharmaceudical companies (to sell more drugs) and providers to increase revenue…or deny services, there is a legitimate and impotant use of the DSM diagnostic manual. Thank you for your reply.

  • Tony Rocco

    I was shocked to learn today that I am in fact mentally ill, or at least I was back when I was a maladjusted punk rocker. The pathologizing of human experience and emotionality is bizarre, arbitrary and inhumane. No reasonable person can accept the definitions of so-called mental illness proclaimed by the self-appointed experts of the DSM-IV. The medical model must be done away with in its entirety and the whole idea of diagnosis discarded. All this misbegotten nonsense is proffered forth by the mental health establishment to make money for psychiatrists, psychologists, insurers and drug companies. It has no place in a civilized world.

    Tony

    • mic

      Well stated Tony!

  • John

    I wonder how much input the pharmaceutical industry had in the development of these new disorders that require drug treatment.

  • MaineCoon

    Psychotyranny’s power to pathologize the human soul is simply the most tyrannical and diabolical of all despotisms. Others can take away possessions, liberty, status, even mortal body. But psychotyranny can take away your very humanity, discrediting and invalidating everything you say, do and are. Boasting of being non-judgmental, it is the ultimate judgmentalism.

    Of course not all outcomes of psycho-pathologizing are that extreme, or even close. But it does happen, and the fact there is even the potential for it to happen at all should not be tolerated. It is the ultimate human abuse, the ultimate weapon of disempowerment against a person or group targeted for annihilation. We are skulls to be parked on the desks of Nazis as trophies of their conquests.

Sponsored by

Become a KQED sponsor