Neuron Culture

As prominent neuroscientist Jane Costello resigns in protest from the DSM-V committee, Danny Carlat says the process near meltdown:

The Fifth Coming of DSM threatens to rend the fabric of American psychiatry. Let’s hope some cool heads in the APA’s leadership can find a way out of this mess.

Stay tuned. The DSM isn’t just a workbook; it’s the theoretical framework and the de-facto prescription guideline for American psychiatry. This level of disagreement and polarization only deepens my belief that the discipline is at crisis point and a crossroads — and in the nasty, scratchy fight over who gets to drive, the question of where to actually go may get a rather rushed answer.

Comments

  1. #1 Neuroskeptic
    July 8, 2009

    Stay tuned indeed – I have a feeling that DSM-V could end up being a great step forward for psychiatry, but not quite in the way the comittee might like!

    With any luck, DSM-V will ends up as such a controversial and questionable document that the wider psychiatric community will have no choice but to start debating the difficult issues about diagnosis and treatment.

    With the previous DSMs, psychiatrists and researchers effectively delegated the difficult stuff to the DSM committees and once the texts were published, everyone could sit back and relax because the hard thinking had been done for them -

    Except it hadn’t been done very well.

  2. #2 Dan
    July 8, 2009

    The Diagnostics and Statistical Manual (DSM), the Shrink’s bible, has been around for over 50 years. Within this manual, there are now possibly nearly 300 mental disorders.

    As a dictionary of suspected mental illnesses, many redefined diagnoses are added to this manual with each edition, and how such disorders are classified and assessed.

    On occasion, a mental disorder is deleted from the DSM, such as homosexuality in the early 1970s. Its purpose, this manual, is to assist mental health professionals to diagnose and classify mental disorders.

    How a group sponsored by for profit pharmaceutical industry corporations that promote psychotropic drugs for various mental issues that may or may not fully exist make the determinations that they do while maintaining objectivity is a phenomenon.

    Published and designed by the American Psychiatric Association (APA), the DSM is also used, I understand, for seeking mental diagnostic criteria to assure reimbursement.

    The DSM is organized, in part, 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 has historically directed the creation of each edition of the DSM, and assigns selected task force members to create this manual. This situation has proven to be controversial.

    The next DSM involves 27 people. About 80 percent of these individuals are male, and only 4 members are not medical doctors. Most have had relationships with the NIH, and about 25 percent of these task force members have had relationships with the WHO.

    Historically, at least a third of task force members have had, or do, have often monetary pharmaceutical industry ties in some way.

    This makes sense, as about one third of the APAs total financing is from the pharmaceutical industry.

    The APA required this task force for the next DSM edition to 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 a concerning rate- with very young children in particular.

    Dan Abshear

  3. #3 Don Meaker
    July 8, 2009

    I quit Psychology when they took some well known abberations out. It was like purging the periodic table of politically incorrect elements.

  4. #4 Dee
    July 10, 2009

    While some of the comments regarding the development of the DSM-V have merit, especially those regarding indiscriminate diagnosing of mental illness and fraudulant perscriptive behaviour, anyone who has ever spent time with a patient suffering from a “mental abberation” knows that these patients are distressed, confused and desperate for help. Brain and mental functioning cannot, as yet, be determined by a simple blood test or X-ray as is the case for some somatic conditions such as diabetes, thus there remains a need to have some diagnostic standardisation and integrity when dealing with a “mentally” distressed patient.

    The inadequacies are there, one cannot dispute that, but there is a need to have an ongoing review of the manual as we gain more and more information about mental functioning. Neurology and psychiatry are on the threshold of some amazing research and work into the impact that aspects such as sunlight, Vit D, the immune system and the endocrine system have on brain functioning and this work is progressing at an astonishing rate. Much of this research is funded by pharmaceutical companies who are at the forefront of finding the metabolic links (I need to add that I have no financial connections to any of these companies but know that if a patient has a neurotransmitter depletion or is severly traumatised, pharmaceutical intervention is required). One would not refuse insulin to a diabetic child or an antibiotic to a septic patient, why then do we want to refuse a serotonin (or other neurotranmitter) depleted individual any type of pharmaceutical assistance.

    Perhaps, it is not the DSM that is at fault but society at large, and old school psychiatry, who refuse to acknowledge the need for a paradigm shift as we get closer to identifying what the rapid change in lifestyle has done to our bodies and brains and those of our young people. We are only now being able to identify what parenting, bad eating and early life stress may do to the our “adult” neurobiology. The days of regarding a child or an adult as either mad, bad or sad are over. There is now more and more evidence that abberations in biology play a role and the DSM-V is striving to provide a basis for understanding these processes without quick blase answers.

  5. #5 Alexander Weman
    July 12, 2009

    @Dee

    I see it in the same way. Soft scienences today can not explain problems of today. Sigmund Freud was and is a man from the past, born as a looser, his life was a bad life because he had no success as a doctor. So he wrote some fictional books and decleared this as schiences. We all should leave this way.
    Alex from Germany

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