When doctors disagree with each other, they usually couch their criticisms in careful, measured language. In the past few months, however, open conflict has broken out among the upper echelons of US psychiatry. The focus of discord is a volume called the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which psychiatrists turn to when diagnosing the distressed individuals who turn up at their offices seeking help. Regularly referred to as the profession’s bible, the DSM is in the midst of a major rewrite, and feelings are running high.
Two eminent retired psychiatrists are warning that the revision process is fatally flawed. They say the new manual, to be known as DSM-V, will extend definitions of mental illnesses so broadly that tens of millions of people will be given unnecessary and risky drugs. Leaders of the American Psychiatric Association (APA), which publishes the manual, have shot back, accusing the pair of being motivated by their own financial interests – a charge they deny. The row is set to come to a head next month when the proposed changes will be published online. For a profession that exists to soothe human troubles, it’s incendiary stuff. […]
Some of the most acrimonious arguments stem from worries about the pharmaceutical industry’s influence over psychiatry. This has led to the spotlight being turned on the financial ties of those in charge of revising the manual, and has made any diagnostic changes that could expand the use of drugs especially controversial. “I think the DSM represents a lightning rod for all kinds of groups,” says David Kupfer of the University of Pittsburgh, Pennsylvania, who heads the task force appointed by the APA to produce the revised manual.
New Scientist: Psychiatry’s civil war
December 17, 2009 at 4:17 am
Superb episode of ‘This American Life’ on how one specific change was made to the DSM…
December 17, 2009 at 6:55 pm
The history of the DSM is strange and scary. It makes sense that the definitions would evolve as our knowledge changes, but changes to the DSM have differnt ramifications than advances in other areas of medicine. With a roll of the DSM, you could be sane one day but diagnosable the next, or vice versa. Check out the brief history on Wikipedia: http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders
Also of note in this context: http://en.wikipedia.org/wiki/Rosenhan_experiment and http://www.bmj.com/cgi/pdf_extract/293/6548/641 and http://ajp.psychiatryonline.org/cgi/content/abstract/138/2/210 (how the DSM can potentially be used to disenfranchise and stifle dissent).