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Petition against DSM V
- Thread starter PerhapsMaybeOk
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Yes. Our instructor posted it for us and invited us to join the debate...if we were up to it.
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What is all this crap about "pathologizing" grief? Nobody made grief a mental disorder and their isnt some high commandment to dx MDD if the clincian thinks the clinical presentation is better accounted for by grief.
Geez, all they did was remove the arbitrary time limit. I thought thats what we wanted... to get away from stringent rules that were not based on science. Nobody's forcing anyone to dx MDD in place of grief reaction. If you do, then that your fault! The DSM isnt responsbile for your poor clincial judgment/skills.
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Hmm very interesting
I didn't know it was the American Psychiatric Association that did the DSM, I always thought for w/e reason that it was the APsychologicalA. The APsychatricAssociation is non-clinical psychs, according to wiki (I would guess they are made up of psychiatrists?)
I think the other APA should do that kind of thing. The thing you linked too, I only skimmed it but it makes good points.
I didn't know it was the American Psychiatric Association that did the DSM, I always thought for w/e reason that it was the APsychologicalA. The APsychatricAssociation is non-clinical psychs, according to wiki (I would guess they are made up of psychiatrists?)
I think the other APA should do that kind of thing. The thing you linked too, I only skimmed it but it makes good points.
EDIT: Well I don't really think psychologists should use intuition to diagnose people... I didn't think the time limits weren't based on science. Really, is it even possible to develop good enough psychological "skills" to be a good judge of stuff like mental illness, from intuitive judgement?
Because I know before they had some of the tests for criminals' liklihood of re-offending, psychs made mostly poor judgment calls
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I dont think anybody does, hence why the DSM was developed. To help standardized and communicate diagnosis.
However, the development of appopriate clinical judgment is an intregal part of becoming a professional in any health (medical or mental health) field. People are not just a "black box" of symptoms that exist in a vacuum then get a diagnosis, right? Hence, judgement is always going to be an important and necessary part of establishing diagnostic thresholds in psychiatry.
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I agree with that, but I didn't think the time limit for clinical depression (diff from one major depressive episode) was more than maybe 6 months. People can be at high risk of suicide if they have a depressive episode, so it's not like saying that's not serious, but I feel like "clinical depression" implies something organic and that the problem is probably not going to fix itself with due time.
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Based on what your wrote, I dont think we are even talking about the same thing here.
You might wanna start reading the research in this area.
This is not the 1950s. We do not debate about things being "organic" any longer. And the term "clinical" used in this context denotes the presence of depressed mood and other associated symptoms that reach the threshold for diagnosis of a Major Depressive Episode due to their impact on the person's functioning (eg.. impairment level). Thats all. There is nothing in the diagnosis that makes assumptions about the etiology of the depressive episode or any possible neurologic substrates of the depressive episode.
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Ditto. OhH, You're at the "You don't know what you don't know" phase--which is totally alright but also good to recognize 🙂
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But you could say that about almost every other diagnosis too. Be it psychosis or personality disorders, the DSM could always stick to "bare science" and leave the rest up to the clinician, and then blame him for overdiagnosing a symptom or for her poor clinical judgment. You surely don't believe that DSM is based on strong science and that this time limit thing was the little piece that did not quite fit!
Gosh, imagine the increase in the number of prescriptions as a result of the removal of the time limit. In an ideal world, where there are no pressures on the clinician and every clinician is educated, intelligent, and very caring for his or her patient, where there is no managed care, no Big Pharma, these changes could have been seen as rather positive. So even two years later, you would not not be pushing someone to take a pill or whatever because you would allow the grieving process to take its time.
However, now it is more likely that the opposite will happen, meaning that larger number of people, only a couple of months into grieving process be asking for meds and the clinician agreeing to prescribe it. Or maybe the clinician brings it up first. In short, I definitely do agree with the authors and with their other concerns:
Attenuated Psychosis Syndrome, which describes experiences common in the general population, and which was developed from a risk concept with strikingly low predictive validity for conversion to full psychosis.
The proposed removal of Major Depressive Disorders bereavement exclusion, which currently prevents the pathologization of grief, a normal life process.
The reduction in the number of criteria necessary for the diagnosis of Attention Deficit Disorder, a diagnosis that is already subject to epidemiological inflation.
The reduction in symptomatic duration and the number of necessary criteria for the diagnosis of Generalized Anxiety Disorder.
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So now the DSM has to play Rx controller and should be specifically designed/enginnered to protect the public from incompetent clinicians, the truth be damned? Um, I think that's the job of the medical boards.
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Allen Frances (chair of DSM IV) has been spearheading much of this debate and frankly, outrage, about the new DSM. An interesting article I came across (yes I know, "Psychology Today") he writes about using the ICD instead of the DSM.
www.psychologytoday.com/blog/dsm5-in.../who-needs-dsm-5
I am wondering... why don't more psychologists do away with the DSM due to controversy and diagreement and more with the ICD??? I dont think the ICD is even taught in psychology programs, or is it?
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Another interesting and informative article, published by ApsychologicalA
http://www.apa.org/monitor/2009/10/icd-dsm.aspx
" *The ICD is produced by a global health agency with a constitutional public health mission, while the DSM is produced by a single national professional association.
* WHO's primary focus for the mental and behavioral disorders classification is to help countries to reduce the disease burden of mental disorders. ICD's development is global, multidisciplinary and multilingual; the primary constituency of the DSM is U.S. psychiatrists.
* The ICD is approved by the World Health Assembly, composed of the health ministers of all 193 WHO member countries; the DSM is approved by the assembly of the American Psychiatric Association, a group much like APA's Council of Representatives.
* The ICD is distributed as broadly as possible at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association's revenue, not only from sales of the book itself, but also from related products and copyright permissions for books and scientific articles."
http://www.apa.org/monitor/2009/10/icd-dsm.aspx
" *The ICD is produced by a global health agency with a constitutional public health mission, while the DSM is produced by a single national professional association.
* WHO's primary focus for the mental and behavioral disorders classification is to help countries to reduce the disease burden of mental disorders. ICD's development is global, multidisciplinary and multilingual; the primary constituency of the DSM is U.S. psychiatrists.
* The ICD is approved by the World Health Assembly, composed of the health ministers of all 193 WHO member countries; the DSM is approved by the assembly of the American Psychiatric Association, a group much like APA's Council of Representatives.
* The ICD is distributed as broadly as possible at a very low cost, with substantial discounts to low-income countries, and available free on the Internet; the DSM generates a very substantial portion of the American Psychiatric Association's revenue, not only from sales of the book itself, but also from related products and copyright permissions for books and scientific articles."
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Is there a way we can read the British Psychological Society's letter without subscribing to the Psychiatric Times? I'm really curious as to what they specifically said.
Edit: Found it at http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5 2011 - BPS response.pdf for those who may also want to read it
Edit: Found it at http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5 2011 - BPS response.pdf for those who may also want to read it
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Well, all those people seem to be against the premise of diagnosis in the field of mental health, period. So whats the point? Are all brit psychologists Rogerians or something?
Moreover, they seem to have fallen into the same flawed reasoning/mindset that you see in the lay public or in a college freshman who takes his first psychology course. That is, that because we write this descriptions down in a book, that we (clincians) now think that all these descriptions represnt a "disease" unto itself. Nobody has ever said any such thing and that notion is clearly and explicitly dispelled if one bothers to read the fist 5 pages of the DSMs current volume. Syndromes, people. Syndromes. And heck, in some cases, just descriptions of maladaptive behavior or behavior patterns (ie., Personality Disorders). The DSM has always been very upfront about this.
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I like the approach of the BPS (and many of the NHS DClinPsy programs of the UK are excellent by the way, very intense, focused and IMO better than the endless PhDs/internships/fellowships of the USA but thats just me.). Their approach can be found in most European countries (i'm currently there). But some of the statements are too much "extreme-leftist anti-psychiatry" IMO.
I mean... (they state)
Schizophrenia
As stated in our general comments, we are concerned that clients and the generalpublic are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. We believe that classifying these problems as ‘illnesses' misses the relational context of problems and the undeniable social causation of many such problems.
For psychologists, our well-being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives.
The general concerns about the scientific validity and utility of diagnoses articulated above are particularly relevant to the diagnosis of schizophrenia. We note in particular, that the invalidity of this diagnosis is such that it is entirely possible for two
individuals with the diagnosis to share no characteristics or symptoms. We also note the poor prognostic and therapeutic validity of this group of diagnoses.
Catatonic Disorder Associated with a
Known General Medical Condition
As stated in our general comments, we are concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. These concerns include the association between physical and psychological health – where we believe it is unnecessary and misleading to represent such associations as ‘psychiatric illnesses' – and ‘catch-all' classifications such as ‘unspecified' or ‘other'.
Wat? Schizophrenia and Catatonic disorder associated with a medical condition are "natural and normal responses to their experiences...responses which do not reflect ilnesses so much as normal individual variation". "Normal"? Catatonia associated with a normal medical condition is a "normal" (but just distressing) response!? I guess that vomiting, coughing and fever are nornal responses as well 😱
I can see the value of this approach in some "personality disorders/issues" (call it what you want) and the over-medicalization of ADHD, Conduct disorder etc. but come on...not everything is like that...
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To weigh in from the psychiatrist POV, I agree with Petran, and Erg your points are as usual valid and poignant. Seems a lot of this falls into debate about the categorical vs. spectrum approach to diagnosis of a mental illness. I think there's downsides to both.
I overheard a speaker describe the method of developing the DSM-III/IV as the "BOGSAT's" method. Bunch of Guys Sitting Around Talking. Meaning expert consensus, which has its place but plateaued in utility about 25 years ago. If that. We need something better. It's just arguable as to whether DSM-V is an improvement or creates more problems than it solves. As my research mentor said (on one of the DSM-V committee's) - "I don't exactly like the way __ committee is working ___ issue, but we agreed that you keep your hands off of my committee on ___, and I'll keep mine off of yours on ___." There's a lot of controversy within the field, even without bringing in More "experts to debate issues."
