DSM- 5- What earlier generations called emotions are now ailments #mustread #mentalhealth


psychiatry
This manuals method is SHEER MADNESS 

What earlier generations called emotions are now ailments

Human lives are governed by emotions.We grieve,we rejoice,we feel fear and anger,we experience doubt and certainty.But if a new psychiatric guidebook is to be believed all these are symptoms of mental ailments.
This diagnostic inflation rears its head in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 ),a guidebook published by the American Psychiatric Association and the go-to reference point for doctors,clinicians and professionals from the healthcare industry.
Allen Frances,Professor Emeritus of Psychiatry at Duke University,writes: If people make the mistake of following DSM-5 … pretty soon all of us may be labelled mad. Frances says that the definitions of mental disorders are written too loosely and applied carelessly by clinicians mainly general practitioners who do most of the prescribing of psychiatric drugs.
The grief I felt when my wife died would now be called major depressive disorder;forgetfulness in older age mild neurocognitive disorder;my gluttony now binge eating disorder;and my hyperactivity attention deficit disorder.As for my twin grandsons temper tantrums,this could be misunderstood as disruptive mood dysregulation disorder.And if you have cancer and your doctor thinks you are too worried about it,theres somatic symptom disorder, he writes.
The American National Institute of Mental Health (NIMH) has also announced that it would be re-orienting its research away from DSM categories.Its director said that the DSM lacks validity and that patients with mental disorders deserve better.
This provoked a reaction from David Kupfer from the DSM task force: Weve been telling patients for several decades that we are waiting for biomarkers.Were still waiting.In the absence of such major discoveries,it is clinical experience and evidence,as well as growing empirical research,that have advanced our understanding of disorders such as autism spectrum disorder,bipolar disorder,and schizophrenia.
Gary Greenberg,a psychotherapist and author,fired back: Youre still waiting How about all the people whom you have diagnosed with what you insist are real illnesses (even if you acknowledge that they arent ) caused by biochemical imblances (which you know dont exist) and treated by drugs (whose mechanisms you dont understand).Theyre still waiting for your knowledge to catch up with your claims,and the idea that your clinical experience and empirical research somehow add up to more than a stopgap measure that is increasingly problematic,that has spawned a drugging of the population that is going to look to future historians like the lead contamination of the Roman water supply does to us this idea is really beginning to wear thin.

 

source- http://www.garygreenbergonline.com/

 

Corporates cashing in on mental-health diagnosis


By Adam McGibbon 

man with head in hands
Are we heading towards a mass-medicated society? Sriram Balla, under a CC License

Are you a disruptive person? Are you occasionally reluctant to part with possessions? Is your child defiant, or prone to temper tantrums? Are you grieving from the death of a close friend? Well, don’t worry; you can get drugs for all of this soon.

On Friday 17 May, the American Psychiatric Association published the fifth edition of its highly influential Diagnostic and Statistical Manual of Mental Disorders (DSM) – the first major update in 13 years. Although a US manual, DSM has global influence.

And that may not be good news. The new DSM has several new additions, including ‘Oppositional Defiant Disorder’ (when a child repeatedly says ‘No’ and acts defiantly), ‘Major Depressive Disorder’ (the experience of grieving) and Disruptive Mood Dysregulation Disorder (temper tantrums).

The DSM is put together by panels of experts in psychiatry. But there is evidence that many of them serve as paid spokespeople for pharmaceutical companies, or conduct industry-funded research.

recent study showed that ‘some of the most conflicted panels are those for which drugs represent the first line of treatment, with two-thirds of the mood disorders panel, 83 per cent of the psychotic disorders panel and 100 per cent of the sleep disorders panel disclosing “ties to the pharmaceutical companies that manufacture the medications used to treat these disorders or to companies that service the pharmaceutical industry.”’

Angry at the scandal, over 10,000 mental health professionals have signed a letter against DSM-5. Allan Frances, the author of DSM-4 and a psychiatrist with 45 years’ experience, is deeply opposed to the changes.

Stooping this low would not be new for ‘Big Pharma.’ Between 1994 and 2005, large pharmaceutical companies spent over $1.3 billion on lobbying politicians in the US alone. Only last week it was revealed that Western pharmaceutical companies used Communist East Germany for illegal drug trials in state-run hospitals in which several test subjects died. These companies do not have our best interests at heart.

In a world where most people assume that the development of new drugs can only ever be positive, they have the power to mass-medicate our entire society. If they can use their influence to convince you that a state of mind is a mental illness, they can sell you something to make it better.

Taking a pill is no substitute for proper mental-health care. This zenith of corporate control over healthcare pushes us one step closer to a dystopian world of mass medication. As the concerned author of the previous DSM Edition (DSM 4) has pointed out, this attempt to medicalize normal everyday experiences is reminiscent of the ‘Somapills’ from Aldous Huxley’s dystopian novel Brave New World –  a world where the entire population takes drugs.

Permalink | Published on May 21, 2013 by Adam McGibbon 

 

In search of a revolutionary road #mentalhealth


K. S. JACOB, The Hindu

Psychiatric diagnoses continue to lack the predictive power required of hard science. A new framework is needed to understand mental health, distress and disease

The American Psychiatric Association (APA) will release the fifth edition of its Diagnostic and Statistical Manual (DSM-5) in May 2013. DSM-5 has been years in the making. The process included planning sessions, international research conferences, review of literature, a series of monographs, secondary analysis of data and field trials involving hundreds of scientists and clinicians, drawn from many countries and disciplines, and feedback from the public. Many interest groups — neurologists, psychologists, insurance and pharmaceutical industries, legal and forensic fraternity, military veterans and anti-psychiatry groups — have been watching the process and outcome closely as the DSM has a wide impact. The Indian Psychiatric Society also submitted its views to the APA.

International standard

The DSM-5 has pursued the basic framework adopted by its forerunners, DSM-III and its successors DSM III R, IV and IV TR. DSM III, with its atheoretical approach, objective diagnostic criteria and specific exclusions, was revolutionary at the time of its introduction in 1980. Its focus on standardised diagnosis and on improving inter-rater reliability had a major impact on psychiatric practice and research. It soon became the international standard.

The absence of laboratory tests to diagnose mental disorders forced psychiatry to focus on clinical presentations for this purpose. The lack of pathognomonic symptoms required the discipline to rely on identifying collections of symptoms to define clinical syndromes. Psychiatric classifications include medical conditions (e.g. delirium, dementia and psychiatric manifestations of medical diseases), severe mental disorders (schizophrenia, bipolar disorders, psychotic depression, and stupor) and stress-related conditions (e.g. depression, anxiety and adjustment disorders).

The DSM laid out objective criteria for diagnosis. It offered differential diagnosis in order to distinguish similar conditions. It allowed psychiatrists working around the globe to read from the same page. It facilitated collaboration and comparison. It improved communication, standardised research, increased, and improved the evidence base. A unified language also helped mental health activism.

Despite major advances and significant progress, the DSM has many critics. Most detractors are free with their criticism, without providing comprehensive solutions to the complex issues facing people with mental illness. Defining mental illness is no simple task. A single definition to partition health, illness and disease has proved to be extraordinarily difficult. The diversity of and heterogeneity within these conditions are major challenges. Typically, patients emphasise distress and suffering, while psychiatrists diagnose and treat “diseases.” Mental disorders include both disease and illness. Nevertheless, diagnostic criteria for psychiatric disorders did not bridge the classical disease-illness divide between physicians’ perspectives and patients’ subjective experience of sickness. In fact, the DSM resulted in language, concepts and frameworks, which contrasted starkly with those held by patients, impeding understanding of the illness experience and diminishing the role of patient narratives. In addition, DSM could not overcome the fact that different etiology and pathology can result in similar clinical presentations, and that a particular cause can produce diverse clinical manifestations. Research and specialist interests also increased manifold the number of diagnostic categories.

Little regard for context

The difficulty in separating disease from distress is a major challenge. The DSM system emphasised symptom counts to identify psychiatric categories, with little regard for the context (e.g. psychosocial stress, personality, and coping). This strategy improves reliability of diagnosis for non-psychotic conditions associated with psychosocial adversity, but also includes people with normal responses to such difficulties. Psychiatry tends to reify diagnosis, making abstract concepts concrete. Psychiatric practice transmutes clinical syndromes (collection of symptoms) into diseases.

The DSM III also suppressed etiological debates about mental disorders and placed them on the back burner. The biomedical model, which undergirds the approach, became dominant, annihilating psychological, behavioural and social conceptualisations. However, the APA argued that reliable diagnoses would result in the recognition of underlying neurobiological substrates and facilitate etiological research; it would lead to the development of new and more effective treatments.

However, the frequent revisions of the DSM, with minor changes often based on limited evidence, also prompted debates on the motivation of the APA. The numerous minor and major disagreements with World Health Organisation’s International Classification of Diseases (ICD) -10 diagnostic categories supported the argument that most changes were arbitrary as there was no agreement among international experts. The DSM had to contend with many charges including medicalising normal reactions, lowering diagnostic thresholds to create spurious “epidemics,” creating new categories without evidence, using medication responses to define categories and playing into the hands of the pharmaceutical industry.

Challenges to diagnosis

Defenders of the DSM argue that its primary purpose is to enable psychiatrists to reliably identify individuals who seek clinical attention, and to facilitate communication among clinicians and researchers. The field of psychiatry has to grapple with the current state of knowledge with its inherent limitations. The lack of laboratory diagnosis, poor understanding of genetic basis and psychological vulnerability, and the need to provide categorical diagnosis for phenomena which lie along a spectrum (e.g. depression, anxiety, cognitive impairment and substance misuse) are difficult challenges.

The most ardent supporters of the DSM acknowledge its imperfections but argue that it reflects our current understanding and state of the science. They contend that DSM-5 is not an attempt to define normal and that being normal is not the same as not having a DSM-5 diagnosis. They argue that having a psychiatric diagnosis is not the same as being insane or crazy, stigmatising labels, which do not apply to the vast majority of people with a DSM diagnosis. They suggest that prescribing medication for any condition in preference to time and labour-intensive psychological interventions is dependent on many factors, including the economic realities of medical practice, and does not necessarily imply medicalising normality.

Pressure from user groups

The use of a single set of criteria, useful to psychiatrists working in specialist settings, in other locations (e.g. definitions for legal use and for reimbursement, in primary care and across cultures) is not without problems. There was also pressure from patient and user groups, as any changes to the DSM-IV categories in the new revision would have affected their claims for disability support and health insurance. Consequently, there were demands to enlarge and to reduce the diagnostic net from different quarters.

A close examination of the DSM-5 suggests the maintenance of status quo. Psychiatric diagnoses and theories, with their technical language, operational criteria, elaborate classificatory systems and empirical data continue to lack the predictive power required of hard science. Its diagnostic systems and models do not explain many aspects of mental health and illness. Human cognition, emotion and behaviour are complex, interconnected and under a variety of influences (e.g. genetics and biology, psychological, social and cultural forces), whose effects cannot be teased out under controlled experimental conditions.

Nevertheless, psychiatric treatments help millions of people lead productive lives. The DSM process and consultation was elaborate and transparent, seeking opinions and evidence from people with diverse backgrounds. Despite its shortcomings, it does reflect the current state of the science. Psychiatry, at this moment in time, has been compared to biology before Darwin and astronomy before Copernicus.

Thomas Kuhn in his book The Structure of Scientific Revolutions described three stages: (i) normal science (routine scientific work) within existing paradigms and a dedication to solving puzzles, (ii) serious anomalies produced by research, which leads to a crisis, and finally (iii) resolution of the crisis by the creation of a new paradigm. Psychiatry today, with its attempt at solving the clinical puzzles and its many anomalies, is awaiting a paradigm shift, which will not only clarify these complex issues but will also provide for a new framework, insight and understanding. Psychiatric research, despite its current attempts at testable conjectures and refutations, is still within a paradigm that seems inadequate for the complexity of the task. Psychiatry awaits its new dawn.

(Professor K.S. Jacob is on the faculty of the Christian Medical College, Vellore. The views expressed are personal)

 

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.

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