DSM-5 round three: can other cries of protest be heard over the clamor of “middle way” voices?
The third and final “draft” of the DSM-5 has been posted, and the various work group members (you remember them, don’t you?) have asked for feedback from the general public. It’s open for comment until June 15th.
I was going through the new draft, checking up on some of my favorite controversies over diagnostic criteria, their intersection with work group member conflicts of interest and pharmaceutical dollars (there being no shortage of any of these things), and thought I might share a few developments.
First, some good news
[Though let me first state that the ultimate good news would be if this thing never went to press at all, if the whole paradigm of labeling, pathologizing, and dehumanizing embodied by this “bible” (aptly named, as it is certainly more of a quasi-religious text with a life of its own that one must both believe in and claim as his own (my schizophrenia, my bipolar, my depression) than a scientific manual containing objective facts) were abandoned. If we let people describe, by themselves and for themselves, their experiences, their realities; if we abided by the Universal Declaration of Mental Human Rights and Freedoms…
But if it’s going to go to print, it would be great if the damage were minimized… so I refer to the following as “good news items” despite my caveat.]
- “Psychosis Risk*” (or “Attenuated Psychosis Syndrome”) – a proposed disorder characterized by “strange thoughts” or hallucinations at least once a week with the potential to become psychotic — will not be included as an official disorder in the DSM-5. This will likely prevent untold thousands of “preventative” prescriptions of anti-psychotics, self-fulfilling prophetic progressions into “chronic schizophrenia” (a phenomenon that really only exists in large numbers where folks are psychiatrized the American way), etc. A very good thing.
- “Mixed Anxiety Depression” isn’t going to be in there either. This was another label that would have vastly expanded the boundaries of what is considered pathological, what might be remedied pharmacologically.
- Rather, they (and quite a few others), will be included in the newly invented “Section III” a sort of purgatory where diagnoses that “need more study” will be named, and tentatively described, but [I gather] will not be official. Whatever that means.
- And a small victory for lovers of acronyms everywhere: our beloved “NOS” [Not Otherwise Specified]remains in this draft of the DSM. For awhile there all the “NOSes” had been transfigured into “NECs” [Not Elsewhere Classified], which simply doesn’t have the same ring to it, and isn’t nearly as punny…er, funny.
NOS [Not Otherwise Specified – a “classification” that refuses to be classified] … nosology [the scientific classification of diseases]… get it???
And now the bad news
This baby IS still going to press, whether we like it or not. Moreover, it’s the middle way detractors’ critique that is being heard and addressed by the media and the APA itself, as is all too clear in this third and final draft.
Middle way protestors (like Allen Frances, for example) are against the DSM-5 in particular, criticizing the development process, the addition of so-called “unscientific diagnoses,” financial conflicts of interest of the developers, etc.
The idea being that we simply need a better process for creating this thing. And that the botched development of the DSM-5, which will result in flaws that could’ve been avoided with more rigorous procedures, is a risky business because it might turn the tide of public opinion against the very institution of the DSM; which would be terrible because we need some kind of DSM in order to treat mental illness at all.
But there’s another camp, led by people like Paula Caplan – I like to think of it as the true DSM detractors. Instead of being against the DSM-5 in particular, this camp (including myself) is against the institution of the DSM, period. Instead of arguing that the DSM-5 is marginalizing, stigmatizing, unscientific, it argues that the practice of diagnosing people itself is all of these things and worst of all… dehumanizing!
In the final draft of the DSM-5 , the Middle Way Critique is addressed, or at least acknowledged, but the Work Group Members stubbornly persist in expanding diagnostic criteria and opening the door for more and more pharmacological interventions (“first line treatments,” they say, mostly in their private publications), their conflicts of interest and grant monies often all too obviously influencing this process.
What can we do about it? Who knows what can be done to stem the rising tide of the “Therapeutic State,” armed with an ever more expansive and “inclusive” definition of mental illness!
But we can start by leaving a strongly worded comment or two on the DSM-5 website about what this “bible,” and the pseudo-scientific/religious beliefs it outlines, has done to our society, our humanity.
*Yes, I linked to an Allen Frances article. Please don’t take that as an endorsement, however!!