Involuntary Transformation: The DSM 5 Controversy Update

Update April 2, 2013 apparently, Psychiatric Times disabled every link sometime recently. One wonders on their motivation to disable links that had been functional for so long...

Original 8-15-2011 Updated June 14, 2012
I recently read, "Inside the Battle to Define Mental Illness," an interview with Allen Francis, M.D., lead author of the DSM IV, and an outspoken critic of the current effort to update the Diagnostic and Statistical Manual, the DSM 5. My hat's off to Dr. Francis for having the professional integrity to assertively state his case.

via The Psychiatric Times:

A Warning Sign on the Road to DSM-V: Beware of Its Unintended Consequences

By Allen Frances, MD | June 26, 2009

Dr Frances was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.

"We should begin with full disclosure. As head of the DSM-IV Task Force, I established strict guidelines to ensure that changes from DSM-III-R to DSM-IV would be few and well supported by empirical data. Please keep this history in mind as you read my numerous criticisms of the current DSM-V process. It is reasonable for you to wonder whether I have an inherently conservative bias or am protecting my own DSM-IV baby. I feel sure that I am identifying grave problems in the DSM-V goals, methods, and products, but it is for the reader to judge my objectivity."

"Much of our effort in developing DSM-IV centered on avoiding possible misuses of the system." here

via Wired Magazine:
Excerpts from The Battle to Define Mental Illness, an interview with Dr. Allen Francis:

"Then an odd, reflective look crosses his face, as if he’s taking in the strangeness of this scene: Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries.” For the first time in two days, the conversation comes to an awkward halt."

"But he recovers quickly, and back in the living room he finishes explaining why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career." read it here.

When I read the APA's response to Allen Francis' criticism in the Psychiatric Times, I was unimpressed. Francis begins his criticism with the statement, "We should begin with full disclosure." The APA's rebuttal was signed by four psychiatrists and was a lame attempt to defend the indefensible. An advertisement for Abilify was alongside of it:

6-14-2012 When updating this article, I discovered the page with the APA's rebuttal had an even larger advertisement for Latuda, that takes you to another page:

Watch Dr. Stahl discuss LATUDA study results

Explore results from Study 3, including the primary and key secondary measures.^1,2

Watch Dr. Stahl review the LATUDA Clinical Trials

Before I was done updating this article, the advertisement was changed to one for Seroquel...I must say, it is more than a little disconcerting to have so much advertising of the neuroleptic drugs in professional journals. It is just as disturbing, if not more so, than the amount of direct to consumer marketing of psychiatric drugs. It is particularly troubling to see so much reliance on pharmaceutical industry funding for psychiatric journals, and the functioning of the APA itself. It doesn't seem ethical to have Direct to Professional marketing for psychiatric drugs in "professional literature." There is no way in hell that these marketing messages do not feed any existent biases a professional may have.

It is no secret that Conflicts of Interest, fraud and corruption have permeated every aspect of psychiatry for some time. In the real world, some psychiatrists have caused a great deal harm to human beings they meant to help. The societal damage has wide-ranging effects, and a negative impact on ALL of US. Why is the APA (and the AACAP) allowing become and it originates with the criminal enterprise that conflicted academic psychopharmacology researchers involved themselves in; intentionally or not. This criminal enterprise continues to defraud all of us through publicly funded programs, and continues to harm patients. In spite of this reality, many psychiatrists do not seem to understand that even if they themselves did not perpetrate any fraud themselves, they have an ethical obligation to have psychiatrists who have, held accountable. It is obviously in everyone's best interest for professional groups to hold their individual members to high ethical standards. It seems to me that unethical conduct has not only been accepted; it has been richly rewarded and honored...

My final observation is this: The APA will conceivably make a great deal of money from the DSM 5. It is preposterous and disingenuous for it's members to suggest a loss of income is motivating Allen Francis; yet failing to mention the anticipated income expected by the American Psychiatric Association with publication of the DSM 5. Psychiatrists who are critical of the APA, have been maligned; and have had their careers dramatically altered. Psychiatrists are punished for being ethical, having integrity and defending their work, i.e. showing all of the data generated, the procedures and parameters used. Such overt ethical integrity is punished in the APA; a person may be forced to defend themselves against malicious attacks and/or ostracized. APA thugs are not even censured.

Psychiatrists that are critical of any aspect of this process, that speak out about the harm caused patients; and that question the secretive process and the lack of validity are castigated. The professionals with the integrity to publicly express disagreement or dissent are said to be impaired or lacking insight by "Key Opinion Leaders" of the APA. The psychopharmachology faithful in the APA have let loose a contagion that has spawned an epidemic of Pharmachosis. Psychiatrists with Pharmachosis have ansognosia; and don't even know it. When experiencing Pharmachosis, a psychiatrist doesn't know what they have, or what they don't have, and they don't even know if they have or have not... (◔‿◔) Completely oblivious to a quantifiable reality recognized by anyone without Pharmachosis, i.e. having a modicum of critical thinking skills.