"was rife with researchers flush with pharma funding devising new psychiatric disorders, none more prominent than bipolar disorder type 2"

Huh? So your saying that bipolar type 2 doesn't exist? Or that it's over diagnosed thanks to big pharma?

reading quite a bit into that felix, but as you wish. my point was that most of the dsm-iv writers had pharma money in their lives and the big new dx in that edition--as in millions of people were dx'd rightly and wrongly--was bp2. end of point.

I was told by someone who is working on the DSM V, and has since become a pharma whore, that the whole bipolar paradigm was going to change, they were going to make 5 catagories of bipolar, - Bipolar1 and 2 as before, but changed unipolar to a subset of bipolar, since it is starting to attract followers that unipolar is bipolar waiting to happen. I was also told that schizophrenia/schizoaffective were going to change to subsets of bipolar as well.

A lot can happen between 2008 and 2012. So I won't hold my breath. But I have met David Kupfer who is in charge of the DSM V and he struck me as a nice person, as well as his wife, ellen frank who is also working on the DSM V. But then, you can be a nice person and an asshat at the same time... imho.

It would seem to me that something that effects so many people (and so much money) would have some sort of public feedback process. Since this will probably touch millions of lives, some positively, others more ambiguously, and everyone at a high price, are we limited to blog posts, comments, and the rarer op-ed in major daily papers to bring attention to this?

It is troubling to me that such a major issue is going to be left to rumors and spin--I'm sure Susan does know what she's talking about but it's nothing that can be reported, and I'm sure that no one needs examples of the spin Pharma is capable of producing to get its way--and nothing can be done to generate more public interest, debate and accountability? Um, no.

I'll admit I don't have the first clue how media works, how to get attention, or how to get started even, but just hoping that some journalist is going to pick up the story is all? A closed door, ultra-secret decision making process that will effect millions and generate billions for a "dirty" and "scandalous" industry isn't enough to get a few editors excited? If not then what's the point of media anymore? Surely that kind of story could fit into almost every single news category today: business, politics, lifestyle, celebrity--just go find some new cultural icon with Type 35 Ambiguous Internet Disorder--science and technology, etc.

Keep up the good work. I love this site!

We're going to need bigger guns to fight these diagnoses. But we have time.

It is true that Dr. Spitzer's third edition of the DSM (1980) successfully deleted homosexuality as a diagnosis.

His research, however, indicated erroneously that gays need not be gay, that they can change if they want to change with reparative therapy. This finding (even then suspect) is thought to have caused hundreds of unsuspecting gay men and women psychological damage, shame for having failed to "change" even though they wanted to. Reparative treatment, I'm pretty sure, is now considered sketchy at best, and unethical at worst, according to the APA and NASW.

What will he have shoppers do? Give all of their money to charity?

The whole DSM makes me tired to be honest even though I know that there are clusters of symptoms that go together and perhaps it can be helpful for a therapist to understand this. Still there are so many people who come up to me and describe their loved ones as "really bipolar" as if this revelation is the be all and end all to every problem that ever existed. The relief in their voices is tangible while I roll my eyes and try to keep myself from screaming, especially when this "truth" is determined after some course on antidepressants or some other psych drug. The problem with the DSM is that it takes attention away from the narrative of someone's life and this is what is truly important, not the predictive power of some stupid group of symptoms or behaviors.

I stopped reading this blog a long time ago due to how much misinformation it contains ... perhaps due to a lack of transparency, perhaps due to a failure to connect all of the puzzle pieces together.

Regardless, after I read the LA Times editorial I was certain you'd have something to write about it.

You are aware that the Research Agenda for DSM-V can be read - by ANYONE, for free, at the APPI website, right? http://appi.org/book.cfm?id=2292

This has been available to the public (e.g., those without academic access) for some time now. I'm sure you'll have a blast dissecting it and posting every out-of-context phrase you can find.

Also, Susan: You're wrong about the Bipolar/Unipolar/Schizoaffective changes for DSM-V. There will be changes made, but not the ones you're describing. I can't comment any further on that.

readers should know that i have queried 'kat'--who works in the psych field--and asked her to identify the misinformation this site spreads around. i'll let you know if she replies.

"Lack of transparency"? Would that be victims and survivors not identifying themselves by their full names or what is "Kat" referring to? That's pretty rich to have someone in the psych field accusing this poor old site of having a lack of transparency when the whole psych profession and big pharma together are replete with major conflicts of interest that are rarely fully disclosed. And "a failure to connect all the puzzle pieces"? You must be kidding. You mean such things as identifying withdrawal for what it really is instead of a relapse to some bogus disorder? I think we're putting the jigsaw together pretty well, thanks -- a lot better than those professionals who like to tell people they're going to be "medicated for life" on the basis of a 15 minute interview.

Kat, 4 the record, Philip knows who my source is, but I cannot reveal it right now.

I also believe Dr. Goodwin's latest edition of his Bipolar book hints at the same thing.

But like I said, what they are saying NOW and what goes into final print in the next four years- anything can happen.

Personally, I wouldn't be surprised if there are big changes in number 5. I mean, if it is mostly the same as number 4, no one would buy the update!!

Susan says: "But changed unipolar to a subset of bipolar since it is starting to attract followers that unipolar is bipolar waiting to happen".

I believe Susan and not Kat. Why would there be a Prozac Survivors Support Group, a Paxil Progress group, an Effexor Activisit Group, an antidepressant facts group, etc. etc., if not for the fact that almost all of these people, both 'depressed' and whatever else- are actually going to be drive insane by antidepressants. It was known as early as 1958 that antidepressants could cause psychosis and paranoia - even in 'normal' people.

So now we have www.SSRIstories.com with over 2,700 cases of people going nuts on SSRIs and SNRIs [and being reported in the media that they were taking these antidepressants] and finally it is "beginning to attract followers that unipolar is bipolar waiting to happen". Of course, this 'bipolar waiting to happen' is not true bipolar, which is actually quite rare. This is artificially, chemically induced bipolar which is happening at an astouding rate all over the world since the intro of Prozac - and every 6th or 7th person began taking Prozac or other SSRIs/SNRIs.

As for the DSM - it is crazy [oxymoron!]. It consists of a list of symptoms and nothing more - no narrative about how or why - what the person's narrative story is, as Sara so exquisitely stated. If only Andrea Yates' physician had asked her if anyone in the family was on lithium. If he had been a competent shrink, then he would have known that the fact that Andrea's father had been on lithium for years would be part of a narrative story and he wouldn't have given her an almost double does of the max for Effexor and then added Remeron, another antidepressant, in her last office visit. If the shrink had only asked if anyone in the family had died recently [Andrea's father] and had she just had a baby - then this narrative would have pointed to the possiblity of a "moodiness" coming to the forefront. If the shrink had warned Andrea and Rusty that Effexor had listed as an adverse reaction "homicidal ideation", then perhaps Andrea's live-in-help wouldn't have left her alone for two hours on that fateful morning.

The DSM is useless & frivilous. What's more - it is dangerous.

God bless the souls of the Yates' children.

Thanks to Kat for the above link, looks like a long night ahead.

I'm with Sarah on being burnt out on the DSM, but looks like the thorough vetting is in order. I'm somewhat familiar with 2 of the proposed additions and I have to wonder if the DSM is potentially shifting toward psychological issues verses strictly psychiatric disorders? I think that would be a good step, myself. Narrative is implied in at least 2 of those new additions, in what's been floated as Relational Disorder, which I've been on board with since 2002. But I think most severe and persistent mental pathology is rooted in relational disorders, whether it's called "mental illness" or "fucked up beyond belief" so getting the Other in place is a positive radical step in my opinion. And it does not skirt the bounds of the DSM, which is not a manual of mental "illness" but mental "disorder", which is actually consistent with its mission and fine by me.

"Relational " locates the disorder as social rather than constitutional. And the counseling verses medicalizing of Relational
Disorder strikes me as intrinsic to the treatment paradigm, though others here might see implications for pharmaceutical intervention, I don't, but it's all speculation at this point. What should be clear though is Relational Disorder is not psychiatry as we know and criticize it, but a recognition of concrete life experience, aka the narrative approach.

I'd feel alot more hopeful about that if not for the potential inclusion of that other narrative approach known as Parental Alienation Syndrome (PAS) which is a sexist "mens rights" construct that was created by mens advocates to win custody battles. Until now I'm pretty sure PAS fell under the rubric of PSYCHOLOGY verses PSYCHIATRY, and the American Psychological Association has defined PAS as a fake, politically motivated "disorder" and denounced the use of psychologists as expert witnesses in divorce proceedings. At least that's where things stood as of a few years ago when I stopped researching the whole tiresome mess, but looks like it's back again.

In sum, I'm wondering if the new DSM going to become inclusive of psychological disorder and if these additions would fall on AXIS I as full-blown mental impairments. Where can I find the answers to these questions, and are they good questions? Anyone?

Dear Philip:

The DSM has been corrupt, and will stay corrupt as long as it exists! Labels make money! More labels, more drugs, more therapy, and the final outcome are more monies flowing into the pockets of the Mental Health establishment!

It would be nice to believe these so called professionals were actually looking out for the best interest of the public and patient's; but by now we know that is about as far from the truth as it can get and pure illusion.

Maybe we can get this renowned team of so called professionals up on the space shuttle for the next moon landing, since the DSM is certainly in some kind of unearthly orbit of intellectual manipulated garbage.

DSM has never been about treatment! It’s a diagnostic tool used to bill insurance companies and the government, and then as an added bonus feature; it labels people for life!

It has never treated or cured a single patient from the day of its conception. They might as well make it in a popup book format with cute picture and cartoons; at least then it would be entertaining, and taken for what it is "fantasy".

Yours Truly,
Stan

The only reason I want to give someone a "relational" diagnosis is so I can pracice family counseling and get reimbursed by third party payers without using a fake diagnosis such as adjustment disorders. I think it is vital to treat families/couples and not just inidividuals, and thus I hope that the inclusion of relational diagnoses will make this easier. It is sad that this is the system to work through in order to do proper therapy, since I don't really want to think of my families as disordered. ...lousy health insurance companies.