Do we Need a Diagnostic Manual for Mental Illness ?


The Guardian

Richard Bentall and Nick Craddock discuss the controversial revisions to the US Diagnostic and Statistical Manual

‘Who will benefit from the proposed revision?’

The way that we think and talk about psychiatric illness has implications for all of us – not only mental health professionals and their patients, but anyone with affected friends and family members, policy-makers struggling to know what services to provide and pharmaceutical companies considering future profits. So it’s unsurprising that a proposed new edition of the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), widely described as the “psychiatrists’ bible”, is causing much furore – but slightly more surprising that much of the dissent comes from within psychiatry.

Since the publication of the third edition in 1980, the DSM has employed a checklist approach to assigning diagnoses. By ticking off the symptoms listed under each disorder, a mental health professional can reach a diagnosis that is likely to be in agreement with the judgment of any other mental health professional. At the time, this seemed to be a huge step forward from earlier approaches, which were highly subjective and led to widespread disagreements about conditions (the diagnosis of schizophrenia, for example, was used much more widely in the US than in Britain). The fourth edition, in 1994, passed without much opposition, but the proposed fifth edition has attracted much criticism – not least from Dr Allen Frances, the American psychiatrist charged with editing its predecessor.

The main focus has been the broadening of psychiatric diagnoses, making an increasing range of behaviours targets of psychiatric concern. (As evidence this is already happened to an alarming degree: last year about one in four US citizens took a psychiatric drug.) For example, it has been proposed that grief should be dropped as an exclusion criterion for the diagnosis of depression, raising the risk that normal grief reactions will be considered evidence of illness. In the case of severe mental illness, the discovery that a large proportion of the population (about 10%) sometimes experience “subclinical” hallucinations and bizarre beliefs has led to the inclusion of an attenuated psychosis syndrome. (Research shows that only about 10% of people who meet these criteria will go on to become severely affected; clearly there is a risk that many will receive toxic drugs unnecessarily.)

Behind these concerns about the expanding scope of psychiatry lies a deeper problem. The proposed revision has been constructed on the basis of clinical consensus – psychiatric folklore institutionalised by committee – rather than scientific research. For example, despite evidence that “schizophrenia” and “bipolar disorder” overlap, they continue to be treated as separate illnesses.

Defenders of the DSM and similar systems argue that some kind of categorical method of diagnosing patients is required to allow communication between clinicians. Critics, such as myself, argue that it’s better to communicate with a detailed and individualised list of a patient’s problems. Either way, an important question is, who will benefit from the proposed revision? As there is no obvious scientific added value compared to the fourth edition of the DSM, and as there are some obvious risks associated with this expansion of diagnostic boundaries, one is bound to ask why there is a need for this revision, or who will benefit from it. It seems likely that the main beneficiaries will be mental health practitioners seeking to justify expanding practices, and pharmaceutical companies looking for new markets for their products.

Nick Craddock: ‘Accurate and prompt diagnosis may be life-saving’

In my view, there are many problems with the DSM approach to diagnosis. There are too many categories, distinctions between diagnoses often seem arbitrary and it is largely driven by expert opinion, rather than solid scientific evidence. Like me, many other psychiatrists in the UK and Europe are similarly sceptical about the fifth edition of the DSM and its expansion of categories and consequent risks of over-diagnosis.

But we need to be clear: if someone is unwell, the first step to delivering effective care is to diagnose what the problem is. Making a diagnosis guides evidence-based clinical decisions. In most situations encountered in mental health, some level of diagnosis is essential to ensure effective help is provided (when needed) and that everyone can have some shared understanding of the situation.

For example, there are many reasons why an adult may develop lethargy, lose weight and become less active and interested in life. This could reflect temporary adjustment to a changing life situation (ie, a normal response to life’s difficulties). The person might have cancer. The person might have heart failure. Alternatively, the person may be experiencing a severe depressive episode and be at immediate risk of suicide. The ways of helping are all very different – and not all medical – and diagnosis is needed to distinguish between the possibilities and implement the right help as early as possible. Accurate and prompt diagnosis may be life-saving.

A diagnosis can provide reassurance that a person’s situation is not unique, mysterious or inexplicable and that there is a body of knowledge and experience that can be brought to bear in providing help. It can reduce stigma by explicitly acknowledging the presence of illness (and, thus, that the feelings or behaviour cannot be dismissed as character weakness or bloody-mindedness).

We should also remember that mental illness and physical illnesses very commonly occur together; this largely explains the fact that people with severe mental illness typically die 20 years earlier than do those without such severe mental illness. Thus, diagnosis of both mental and physical illness is a vital part of the care that those with mental health problems should expect.

The fifth edition of the DSM is an American development. In the UK we use the World Health Organisation‘s International Classification of Diseases (ICD), so the DSM does not directly affect NHS patients. Prompt and accurate diagnosis and recognition of mental illness and related health problems is the cornerstone of high-quality health services. That should be our focus in the UK.

Immediate Release- Protest human sacrifice of a dalit worker


NARABALI VIRODHI VEDIKE BENGALURU-  Today feb 14  PROTEST AT at 4:30 pm, townhall, bangalore

PRESS STATEMENT, 14 FEBRUARY 2012

The human sacrifice that took place at Thirumaladevara Koppa in Ranebennuru taluk of Haveri district on 26 November 2011 has already drawn the attention of the people allover the state. A 17 year old dalit boy by name Basavaraja Kadimani was sacrificed to set right Vastu Dosha of the house of Basavanagowda of the same village. Basavaraja was working with Basavanagowda , a land lord. as a tractor driver. In fact almost all the members of his family had worked for the land lord at one time or the other in the past.

Nijalinga swamy, popularly known as Tatu Ajja of Niralagi near Gadag used to visit Basavanagowda very often . Under his guidance the land lord had already performed many rituals on various occasions. On 26th November, 2012 Basavaraja went to his master’s place at night and did not return. Next day early in the morning the members of his family, father, mother and elder brother were informed by the police of Haligeri police station that Basavaraja had been injured in a fight with Ninganagowda, the son of Basavanagowda and had been hospitalized. The police took them not the hospital, but to the police station where they told them that their boy had been killed and not just injured. They were brought to a spot near their village where they saw a gunny sack containing the dead body of Basavaraj. The body bore marks of vermilion and turmeric . It also had a hole on the forehead. An eye had been plucked out and a few teeth ere missing. The parents and others suspected that it was a case of sacrifice and complained to the police on those grounds. But the police did not register it as case of sacrifice but continued to maintain that it was only a murder . Later on the villagers also found traces of blood sprinkled all over around the house. When the police opened the doors of the house nearly 50 days after the incident blood marks were also found inside the building. Still the police were not ready to consider the angle of human sacrifice in this case. Ninganagowda , the son of Basavanagowda had surrendered to the police saying that he had killed Basavaraja.

Members of Peoples’ Democratic Forum and Swabhimani Dalita Shakti visited the village on 9th January 2012 met the villagers including the parents and relatives of Basavaraja and also the police officer(Dy S P of Ranebennuru) investigating the case. We found that in spite of the evidence and complaint by the parents the police are not ready to consider the angle of human sacrifice seriously. They have been insisting that it was only a murder committed by Ninganagowda suspecting illicit relationship between Basavaraja and his (Ninganagowda’s) wife which on verificatio does not sound credible. The people of the village and also various other progressive elements of the area held a protest rally and demonstration at

Ranebennuru on 30th January 2012 to press the demand to consider it as not merely a murder but as human sacrifice. It is only then that the sorcerer, Tatu Ajja’s role will be exposed. It is essential not merely to find out the truth but also to prevent any recurrence of such superstitious practices in future. But some how the police of Ranebennuru are not prepared to move in that direction . This will only protect the sorcerer and the head of the family Basavanagowda.

Already an application has been made to the State Human Rights Commission and an appeal to the honourable governor of Karnataka has been submitted through the Tahasildar of Ranebennuru.

Demands:

1)The police of Ranebennuru should take the complaint of the parents of Basavaraj seriously and treat it as a case of human sacrifice.

2)In case of the local police failing to do so the case should be handed over to the CBI by the state government.

3)The sorcerer Tatu Ajja and the head of the family Basavanagowda who was responsible for the murder/sacrifice should be arrested.

3)Compensation should be paid to the family according to rules existing in such cases.

Shivalingam

(Swabhimani Dalita Shakti)

Nagari Babaiah

(People’s Democratic Forum)

Nagaragere Ramesh

(Peoples’ Democratic Form)

Kranti Govind

(Swabhimani Dalita Shakti)

Ramadas Rao

(P U C L)

 

 

Indian Govt clears national data sharing policy


NEW DELHI : In a move that will help in effective framing of national policies and planning, government today gave nod to a policy on sharing data and information among various departments.

The National Data Sharing and Accessibility Policy, cleared by the Union Cabinet, will make it mandatory for every department to share data.

The Tourism Ministry, for example, will now share its foreign and domestic tourist arrival data with any other ministry, if required.

“We already share our foreign tourist arrival data with the Home Ministry and External Affairs Ministry. Now this data will be made available for other ministries also,” a Ministry official said.

“The data and information will be shared in both human readable and machine readable forms through a network all over the country in a proactive and periodically updatable manner,” a government statement said.

The sharing will be in consonance with the policies, acts and rules of the Government, therefore, permitting a wider accessibility and use of public data and information, the statement added.

The policy will apply to all data and information created, generated, collected and achieved using public funds provided by the Union Government directly or through authorised agencies by various ministries, departments, organisations, agencies and autonomous bodies, the statement said.

Indian doctors consider alternatives to nuclear energy


International Physicians for the Prevention of Nuclear War is a non-partisan federation of national medical organizations in 62 countries, representing tens of thousands of doctors, medical students, other health workers, and concerned citizens who share the common goal of creating a more peaceful and secure world freed from the threat of nuclear annihilation. IPPNW has remained a leader in the global movement for a world without nuclear weapons, launching the International Campaign to Abolish Nuclear Weapons (ICAN) in 2007, and working with numerous other NGOs to promote a Nuclear Weapons Convention that would outlaw these instruments of mass extermination under international law. Indian Doctors for Peace and Development (IDPD), IPPNW’s Indian affiliate, held an interactive session on nuclear energy on October last year  at the India International Centre in New Delhi. Professor Andreas Nidecker, President IPPNW Switzerland, and General Vinod Saighal were the featured speakers. The session was moderated by Dr. L.S. Chawla, President of IDPD. Dr. Nidecker presented medical arguments against the civil use of nuclear power, explained in detail the reasons why nuclear energy is not a viable source for meeting the world’s energy needs, and reported that after the Fukushima nuclear reactor crisis the Swiss government decided to phase out nuclear energy. He described the harmful effects of radiation throughout the nuclear chain — from uranium mining to nuclear waste disposal. Fukushima, he said, has put a full stop to the false claims about the safety of nuclear energy. Dr. Nidecker noted several specific drawbacks to nuclear energy, including rising costs, security issues, the absence of a solution to the waste problem, intense water usage, environmental contamination, the health effects of exposure to ionizing radiation, and the increasing risks for nuclear proliferation, and the diversion of investments away from better, safer, and more sustainable alternatives, such as wind and solar power technologies. General Saighal urged the development of a strong antinuclear movement. Dr. Chawla pointed out that nuclear energy is fraught with dangers to the health of the people, particularly those living around nuclear facilities. He said these problems had been confirmed by the IDPD study on the health effects of people living around Jadugoda uranium mines. Dr. Arun Mitra, General Secretary of IDPD, said that the Indian people have to build a strong resistance against the nuclear policy of the government “against all the odds posed by the government and the pro-nuclear lobby in our country.” Read the Report hereConnect with them at -http://peaceandhealthblog.com/

The Seed Emergency: The Threat to Food and Democracy


Vandana Shiva

Patenting seeds has led to a farming and food crisis – and huge profits for US biotechnology corporations.

The seed is the first link in the food chain – and seed sovereignty is the foundation of food sovereignty. If farmers do not have their own seeds or access to open pollinated varieties that they can save, improve and exchange, they have no seed sovereignty – and consequently no food sovereignty.

The deepening agrarian and food crisis has its roots in changes in the seed supply system, and the erosion of seed diversity and seed sovereignty.

Seed sovereignty includes the farmer’s rights to save, breed and exchange seeds, to have access to diverse open source seeds which can be saved – and which are not patented, genetically modified, owned or controlled by emerging seed giants. It is based on reclaiming seeds and biodiversity as commons and public good.

The past twenty years have seen a very rapid erosion of seed diversity and seed sovereignty, and the concentration of the control over seeds by a very small number of giant corporations. In 1995, when the UN organised the Plant Genetic Resources Conference in Leipzig, it was reported that 75 per cent of all agricultural biodiversity had disappeared because of the introduction of “modern” varieties, which are always cultivated as monocultures. Since then, the erosion has accelerated.

The introduction of the Trade Related Intellectual Property Rights Agreement of the World Trade Organisation has accelerated the spread of genetically engineered seeds – which can be patented – and for which royalties can be collected. Navdanya was started in response to the introduction of these patents on seeds in the General Agreement on Tariffs and Trade – a forerunner to the WTO – about which a Monsanto representative later stated: “In drafting these agreements, we were the patient, diagnostician [and] physician all in one.” Corporations defined a problem – and for them the problem was farmers saving seeds. They offered a solution, and the solution was to make it illegal for farmers to save seed – by introducing patents and intellectual property rights [PDF] on those very seeds. As a result, acreage under GM corn, soya, canola, cotton has increased dramatically.

Threats to seed sovereignty

Besides displacing and destroying diversity, patented GMO seeds are also undermining seed sovereignty. Across the world, new seed laws are being introduced which enforce compulsory registration of seeds, thus making it impossible for small farmers to grow their own diversity, and forcing them into dependency on giant seed corporations. Corporations are also patenting climate resilient seeds evolved by farmers – thus robbing farmers of using their own seeds and knowledge for climate adaptation.

Another threat to seed sovereignty is genetic contamination. India has lost its cotton seeds because of contamination from Bt Cotton – a strain engineered to contain the pesticide Bacillus thuringiensis bacterium. Canada has lost its canola seed because of contamination from Roundup Ready canola. And Mexico has lost its corn due to contamination from Bt Cotton.

After contamination, biotech seed corporations sue farmers with patent infringement cases, as happened in the case of Percy Schmeiser. That is why more than 80 groups came together and filed a case to prevent Monsanto from suing farmers whose seed had been contaminated.

As a farmer’s seed supply is eroded, and farmers become dependent on patented GMO seed, the result is debt. India, the home of cotton, has lost its cotton seed diversity and cotton seed sovereignty. Some 95 per cent of the country’s cotton seed is now controlled by Monsanto – and the debt trap created by being forced to buy seed every year – with royalty payments – has pushed hundreds of thousands of farmers to suicide; of the 250,000 farmer suicides, the majority are in the cotton belt.

Seeding control

Even as the disappearance of biodiversity and seed sovereignty creates a major crisis for agriculture and food security, corporations are pushing governments to use public money to destroy the public seed supply and replace it with unreliable non-renewable, patented seed – which must be bought each and every year.

In Europe, the 1994 regulation for protection of plant varieties forces farmers to make a “compulsory voluntary contribution” to seed companies. The terms themselves are contradictory. What is compulsory cannot be voluntary.

In France, a law was passed in November 2011, which makes royalty payments compulsory. As Agriculture Minister Bruna Le Marie stated: “Seeds can be longer be royalty free, as is currently the case.” Of the 5,000 or so cultivated plant varieties, 600 are protected by certificate in France, and these account for 99 per cent of the varieties grown by farmers.

The “compulsory voluntary contribution”, in other words a royalty, is justified on grounds that “a fee is paid to certificate holders [seed companies] to sustain funding of research and efforts to improve genetic resources”.

Monsanto pirates biodiversity and genetic resources from farming communities, as it did in the case of a wheat biopiracy case fought by Navdanya with Greenpeace, and climate resilient crops and brinjal (also known as aubergine or eggplant) varieties for Bt Brinjal. As Monsanto states, “it draws from a collection of germ-plasm that is unparalleled in history” and “mines the diversity in this genetic library to develop elite seeds faster than ever before”.

In effect, what is taking place is the enclosure of the genetic commons of our biodiversity and the intellectual commons of public breeding by farming communities and public institutions. And the GMO seeds Monsanto is offering are failing. This is not “improvement” of genetic resources, but degradation. This is not innovation but piracy.

For example, the Alliance for a Green Revolution in Africa (AGRA) – being pushed by the Gates Foundation – is a major assault on Africa’s seed sovereignty.

Agribusiness

The 2009 US Global Food Security Act [PDF] also called the Lugar-Casey Act [PDF], “A bill to authorise appropriations for fiscal years 2010 through 2014 to provide assistance to foreign countries to promote food security, to stimulate rural economies, and to improve emergency response to food crisis, to amend the Foreign Assistance Act of 1961 and for other purposes”.

The amendment to the Foreign Assistance Act would “include research on bio-technological advances appropriate to local ecological conditions, including genetically modified technology”. The $ 7.7bn that goes with the bill would go to benefit Monsanto to push GM seeds.

An article in Forbes, titled “Why Uncle Sam Supports Franken Foods”, shows how agribusiness is the only sector in which US has a positive trade balance. Hence the push for GMOs – because they bring royalties to the US. However, royalties for Monsanto are based on debt, suicidal farmers and the disappearance of biodiversity worldwide.

Under the US Global Food Security Act, Nepal signed an agreement with USAID and Monsanto. This led to massive protests across the country. India was forced to allow patents on seeds through the first dispute brought by the US against India in the WTO. Since 2004, India has also been trying to introduce a Seed Act which would require farmers to register their own seeds and take licenses. This in effect would force farmers from using their indigenous seed varieties. By creating a Seed Satyagraha – a non-cooperation movement in Gandhi’s footsteps, handing over hundreds of thousands of signatures to the prime minister, and working with parliament – we have so far prevented the Seed Law from being introduced.

India has signed a US-India Knowledge Initiative in Agriculture, with Monsanto on the Board. Individual states are also being pressured to sign agreements with Monsanto. One example is the Monsanto-Rajasthan Memorandum of Understanding, under which Monsanto would get intellectual property rights to all genetic resources, and to carry out research on indigenous seeds. It took a campaign by Navdanya and a “Monsanto Quit India” Bija Yatra [“seed pilgrimage”] to force the government of Rajasthan to cancel the MOU.

This asymmetric pressure of Monsanto on the US government, and the joint pressure of both on the governments across the world, is a major threat to the future of seeds, the future of food and the future of democracy.
TRANSCEND Member Prof. Vandana Shiva is a physicist, ecofeminist, philosopher, activist, and author of more than 20 books and 500 papers. She is the founder of the Research Foundation for Science, Technology and Ecology, and has campaigned for biodiversity, conservation and farmers’ rights, winning the Right Livelihood Award [Alternative Nobel Prize] in 1993. She is executive director of the Navdanya Trust

Source: TRANSCEND Media Service, Sunday, February 12, 2012

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