A rising controversy over the DSM-5, the new edition of the so-called Bible of psychiatry, heated up to a flashpoint last weekend as the book was launched at the 166th annual meeting of the American Psychiatric Association.
Criticism of the new psychiatric manual has issued from sources as diverse as the director of the National Institute of Mental Health and the activists of Occupy Psychiatry.
Occupy Psychiatry mounted a protest outside the Moscone Center in San Francisco, where the APA was meeting. Among the protesters was Portland mental health activist, coach and group facilitator Chaya Grossberg, who said Occupy Psychiatry drew some respectful attention from APA members.
“Some of the psychiatrists stopped and listened, some for almost the whole time!” Grossberg said yesterday.
In recent weeks, however, psychiatrists were likelier to be sniping at each other.
Shrink vs. Shrink
NIMH director Thomas Insel, MD, criticized the manual’s “lack of validity” April 29, calling it “at best, a dictionary” that defines the exact set of labels it creates. “Patients with mental disorders deserve better,” he wrote.
But David Kupfer, MD, chair of the DSM-5 task force, defended the diagnostic manual and struck back at Insel in a May 6 statement, saying the NIMH director’s proposed replacement for the DSM — use of biological and genetic markers for diagnosis and treatment — “cannot serve us in the here and now.”
Though he said he hopes such a system will exist someday, Kupfer called it “disappointingly distant. We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”
Fellow psychiatrists parried in the New York Times letters section after professor of psychiatry Ronald Pies, MD, scoffed at criticism of the DSM. “There is nothing inherently dehumanizing or ‘stigmatizing’ about a psychiatric diagnosis,” he wrote, before apparently contradicting himself with a reference to “society’s animus and prejudice toward those with mental illness.”
Victor Altshul, MD, a psychiatrist in New Haven, pointed out that “responsibility for the stigmatization of large groups of people can partly be laid at our door. Just ask gay people who were around before 1973, when homosexuality was finally removed from the DSM.”
And psychiatrist Leon Hoffman, MD, joined the dissent: “The problem with the DSM is that psychiatry over at least the last four decades has attempted to categorize mental and psychological manifestations as distinct illnesses, similar to the categorization of medical and surgical illnesses, instead of recognizing that the best way to understand psychological health is on a spectrum.”
“All of us are a little depressed, a little obsessional, a little histrionic and a little borderline,” wrote Hoffman. “Some of us have a little more of one of these qualities and less of one of the others. We seek help when one of our traits causes us or those around us too much psychic pain.”
Overdiagnosis a Threat
Specific criticisms of the DSM’s fifth edition center around certain diagnostic criteria that threaten to make the categories so broad that overdiagnosis is a looming risk. For example:
- People with normal grief and sadness after the death of a loved one, previously excluded from a depression diagnosis, might now be diagnosed with major depression.
- Diagnosing a child’s temper tantrums as “disruptive mood dysregulation disorder” could saddle normal kids with a mental illness label.
- Older people who sometimes find it more difficult to do everyday tasks or have an occasional “senior moment” might now be diagnosed with “mild neurocognitive disorder.”
- Excessive thoughts or feelings about pain or other discomfort is now termed “somatic symptom disorder,” which could give cancer patients another, perhaps unwarranted, diagnosis.
- It will be easier to qualify for a diagnosis of ADHD, a condition many say is already overdiagnosed.
As of today, psychologists had collected 14,888 signatures on an online petition raising questions about the DSM-5 and asking for a collegial reconsideration.
Occupy Psychiatry in S.F.
For the 40 or so Occupy Psychiatry protesters outside the Moscone Center, and many of their supporters, the problem is broader — and deeper — than changes from the previous manual, the DSM-IV. The problem is psychiatry itself.
“The issue is not about this edition of the DSM,” said PJ Moynihan, who was not at the protest, busy instead with the Open Paradigm Project, a social media campaign giving voice to people who reject psychiatric labeling. “It is a broader, philosophical issue about how we respond to human emotion, or life challenges.”
Moynihan added, “My experience in listening to countless stories from individuals whose lives have been severely damaged by psychiatric diagnosis, and consequently psychiatric medication, is that the point of intervention by psychiatry, due to whatever the circumstances may be, is more harm than good.”
“Telling someone who is going through a period of overwhelm, or emotional difficulty, as well as their support system of family and friends, that they have a biological brain disease that is most effectively treated with long term medication, is devastating to the individual, informs how their support network responds or views them, and not founded in any real science or proven biological markers.”
“In short,” said Moynihan, “we need a paradigm shift in mental healthcare, not variations on the prevailing model.”
Speakers at the protest, most of whom identified as psychiatric survivors, included:
- Attorney Ted Chabasinski: “The increased labeling and drugging of children, and the way the new DSM puts everyone at risk for being called ‘mentally ill’ must be stopped. Everyone must realize that they too can be called crazy, not just those who have already been dragged into and trapped by the system.”
- Licensed therapist and human rights activist Michael Cornwall, Ph.D.: “The profession of psychiatry lives in a collective state of denial. Psychiatrists are true believers with a religious fundamentalist type of fervor that allows them to routinely injure, and frequently hasten the death of those they are sworn to heal. But the reckoning is upon them. Their blatant human rights violations will not stand the light of day.”
- Attorney James B. (Jim) Gottstein, Esq.: “Hundreds of thousands of people are locked up and drugged or electroshocked against their will every day under the auspices of the American Psychiatric Association. These are human rights abuses on a massive scale in violation of United States and International Law. The American Psychiatric Association must be held accountable for its role in these horrors.”
Chaya Grossberg, the Portland activist, said the protest was effective and important. “Hundreds of people watched on Livestream,” she said. “People came to the protest for community and solidarity, from Alaska, Portland, Los Angeles, and even Alberta, Canada.”
For many, the protest had a personal impact. Said Grossberg, “Some people who came have been isolated, trying to come off of, or recover from, psych drugs for many years. This protest helped them to know they are not alone, and their voice matters and can be heard.”