January 19, 2009

DSM-V Controversies


dsmv controversies.jpg

If the front page of Psychiatric Times ran a story called DSM-V Controversies, and it contained this picture, what would you think the article would be about?



The picture certainly conjures up the concept of dogma.  Maybe you'd think it was about what belongs in the DSM and what does not; what constitutes disease, where does normal behavior stop and pathology begin?  Maybe it would be about the  larger questions of the appropriateness of basing a science on epidemiology and inference.

And certainly, those are the main controversies in psychiatry.  But this article doesn't mention any of those controversies. 

No.  The entire article is about conflicts of interests, financial ties of the committee members, and setting up rules to prevent the undue influence of "for profit" entities on psychiatry.  (As if psychiatry itself wasn't for profit?)

You're thinking, so what?

Be careful.  This this isn't an article about financial conflicts on interest in the creation of the DSM; it is an article about the controversies surrounding the DSM, of which this is the only one mentioned.

The difference is subtle, but absolutely vital.   The purpose of the article is to draw your attention away from the existence of the other more important controversies, and focus on the trivial one.  It  pretends to say, "here is one of the controversies, of which there are many others as well."  But by only hammering at the financial, it stops being an example and starts being a patsy.

This is what can be a called a morality play.  It doesn't require thought, only feeling and intuition, and elicits strong reactions and emotions.  All of this is to distract the masses from the fundamental problems, which require considerable intellectual sophistication and are anyways rarely settled, onto the more immediately rewarding moral opprobrium.  Debating about whether a guy who earned $20,000 in Glaxo speaker's fees should be allowed to weigh in on bipolar depression is a far easier and more satisfying argument than "what is bipolar depression?"

You say: surely you aren't suggesting that the authors of the DSM, and even Psychiatric Times, are engaged in a coordinated conspiracy to divert attention from the structural problems of psychiatry and on to meaningless discussions about payoffs and payouts?

No.  They're not trying to distract us, they are trying to distract themselves.  They're the parents of little Jimmy, protesting to the school administrators that that the words have been  changed to "We Wish You A Merry Holiday" so that they don't have to contend with the fact that those carols are the only religious instruction the parents have bothered to provide him. 

It is endless Congressional debates about corporate jets and executive pay, so that...






Comments

The obsession with financia... (Below threshold)

January 19, 2009 4:59 PM | Posted by Neuroskeptic: | Reply

The obsession with financial conflicts of interest relies upon a very naive materialistic view of human nature. Smeone who has spent their entire life, say, researching antidepressants, or doing psychotherapy, has at least as much of a vested interest in such matters as someone whose salary depends on it.

At the end of the day, doctors and therapists are going to make money - and most of them could earn twice as much in a financial profession if they so chose. A lifetime poured into something is the biggest interest there is.

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An article mocking use of t... (Below threshold)

January 19, 2009 9:17 PM | Posted by Anonymous: | Reply

An article mocking use of the straw man... ending with a reference to the "war on Christmas." Wow. Can I have some irony with that?

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Towards the end of the arti... (Below threshold)

January 20, 2009 4:34 PM | Posted by SusanC: | Reply

Towards the end of the article, it briefly mentions some of the actual controversies: Internet Addiction Disorder, Sensory Processing Disorder, Gender Identity Disorder, and so on.

Some of these controversies are about more than just corruption by Pharma money. The GID controversy, for example, involves homophobia, the gay rights movement, the changing roles of men and women in modern society, and so on. Internet Addiction Disorder is open to accusations of being a moral panic about social changes caused by new technology.

But in most of these individual controversies, the same issue keeps popping up as a common factor. To put it very bluntly, is disorder X a conspiracy by the psychiatric profession to defraud the health insurance companies (in the UK, the National Health Service)? Or has Pharma marketing convinced doctors of the existence of bogus diseases?

But if this is a concern, simple restrictions on payments to the committee members don't go nearly far enough. Even if they've not been bribed personally and recently, they will base their recommendations on the published literature, which might be full of fraudulent experiments. (It need not be a blatant as paying a researcher to falsify data. Supressing negative results is easier than falsifying postive ones, etc. Oh, and in the case of the GID subcommittee, there's Dr John Money). They will have attended lectures at University, which are are based on research which is now extremely suspect. And so on.

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What an incredibly poignant... (Below threshold)

January 21, 2009 1:37 AM | Posted by Zachary Taylor: | Reply

What an incredibly poignant observation. Thank you for drawing my attention to the subtleties of the article.

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The Diagnostics and Statist... (Below threshold)

January 23, 2009 11:38 AM | Posted by Dan: | Reply

The Diagnostics and Statistical Manual, the Shrink's bible, has been around for over 50 years, and now possibly contains nearly 300 mental disorders. Many are created and added to the DSM as each new edition is created. On occasion, a mental disorder is deleted from the DSM, such as homosexuality in the early 1970s.

Published by the APA, it is also used, I understand, for seeking mental diagnostic criteria to assure reimbursement. The DSM is also often used as a reference to validate suspected assessments by the psychiatrist and the DSM is organized by the following:

I- Mental disorders
II- mental conditions
III- Physical disorders/syndromes, medical conditions (co-morbidity)
IV- Mental disorder suspected etiology
V- Pediatric assessments

The APA is creating the next DSM, DSM-V, and has had its task force members assigned to this next DSM edition sign non-disclosure agreements, which is rather absurd and pointless. Lack of transparency equals lack of credibility because of these agreements of the content of the next DSM. It opposes any recovery model necessary regarding such disorders, I believe.

The DSM should be evaluated by another unrelated task force or a peer review of sorts to assure objectivity. This is particularly of concern presently, as many more are diagnosed with mental dysfunctions presently at an alarming rate- children in particular,

Dan Abshear



________________________________________

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The illustration accompanyi... (Below threshold)

January 25, 2009 12:20 PM | Posted by Jack Coupal: | Reply

The illustration accompanying Kaplan's Psychiatric Times piece appears to have been chosen buy someone who didn't read Kaplan's piece, or didn't understand it.

As a pharmacist, I'm amazed at the hatred (jealousy?) many express toward physicians and Ph.D. scientists who do privately-funded psychiatric research, and make a name for themself in the field. If their expert claims and opinions in scientific publications are later shown to be wrong or misinterpreted - and that really does occur - such experts' professional careers can easily self-destruct, and quickly.

The pharmaceutical companies sponsoring the "expert" also wind up with a diminished scientific reputation, and reduced revenues and share price.

Having the courage to engage in cutting-edge clinical research which is by nature expensive is a double-edged sword that can destroy a professional life as well as reward one.

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As a pharmacist, I'm amazed... (Below threshold)

March 24, 2011 11:37 PM | Posted by mbt shoes: | Reply

As a pharmacist, I'm amazed at the hatred (jealousy?) many express toward physicians and Ph.D. scientists who do privately-funded psychiatric research, and make a name for themself in the field. If their expert claims and opinions in scientific publications are later shown to be wrong or misinterpreted - and that really does occur - such experts' professional careers can easily self-destruct, and quickly.

Vote up Vote down Report this comment Score: -1 (3 votes cast)