December 18, 2008

DSM-3 Creator Criticizes DSM-5 Secrecy

Most of you are aware that the American Psychiatric Association is at work developing DSM-5, slated for release in 2011 or 2012. There's already been criticism of odd new disorders proposed for the new edition of psychiatry's Bible. And now, via an article in yesterday's New York Times, comes word that Robert Spitzer, the creator of DSM-3, which in 1980 reclassified mental illnesses into disorders and is the most influential edition of the DSM ever, is pretty pissed off about how DSM-5 is being put together in near total secrecy.

"Some critics, however, say the secrecy is inappropriate.

"'When I first heard about this agreement, I just went bonkers,' said Dr. Robert Spitzer, a psychiatry professor at Columbia and the architect of the third edition of the manual. 'Transparency is necessary if the document is to have credibility, and, in time, you’re going to have people complaining all over the place that they didn’t have the opportunity to challenge anything.'"

Psychiatrists who are working on the new DSM are allowed to accept up to $10,000 a year from pharma companies.

Look, it's my view that the APA is out of its mind if it thinks it's going to run a secretive process that will likely end up producing new disorders for kids and adults and not have that process have some level of public review much less review by psychiatrists outside of the DSM committees. The APA is even crazier to allow DSM authors to continue to take pharma money during the process.

Under current procedures, DSM-5 will be a tainted, deeply-conflicted document and will embarrass the profession further at a time when it could probably use less embarrassment.

Posted by Philip Dawdy at December 18, 2008 12:00 PM
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Comments

The DSM-V will probably make 50% human behaviours "mental illnesses" that the term "mental illness" will be made meaningless much to the delight of anti-psychiatric aficionados. In other words, they are going to shoot themselves in the foot.

Posted by: Tony at December 18, 2008 01:09 PM

I don't know about tainted, but the DSM always been deeply conflicted, particularly with regard to homosexuality.

I can imagine the DSM, ultimately, becoming simply a "psychiatric"-specific Physician's Desk Reference (PDR).

Posted by: Christine at December 18, 2008 03:16 PM

Yes indeed. Embarrassing. And dumb. And downright shameful. They must know the project would simply fall apart under open scrutiny.

Embarrassed to be a psychiatrist,

GC

Posted by: Gene Combs at December 18, 2008 07:00 PM

two words..

Sick..

Fucks..

Posted by: truthman30 at December 18, 2008 07:59 PM

I have a copy of the DSM III which I needed to use for college. I also have a copy of the DSM IV that a "friend" left behind.

I cannot resell the III and as for number IV, I used it at one time to press some flowers. I didn't want to use my Grandmother's bible.

Well, it was good for one thing. ;-)

Posted by: susan at December 19, 2008 12:01 AM

I read the NYT piece that Philip linked, and it contained some interesting quotes.

"The American Psychiatric Association says the contributors’ nondisclosure agreement is meant to allow the revisions to begin without distraction and to prevent authors from making deals to write casebooks or engage in other projects based on the deliberations without working through the association.

"In a phone interview, Dr. Darrel A. Regier, the psychiatric association’s research director, who with Dr. David Kupfer of the University of Pittsburgh is co-chairman of the task force, said that experts working on the manual had presented much of their work in scientific conferences.

"'But you need to synthesize what you’re doing and make it coherent before having that discussion,' Dr. Regier said. 'Nobody wants to put a rough draft or raw data up on the Web.'"

This sounds reasonable to me. They have "presented much of their work in scientific conferences", and are keeping detailed transcripts of their deliberations, and once they have an acceptable draft in place, then "that discussion" about the draft's pros and cons can be had in a more public forum.

I'm not saying that the DSM-V will be perfect. It will certainly have its share of flaws, just as all human endeavors do. And I am also not saying that once an acceptable draft of the DSM-V is completed that a transparent and open discussion of its merits will be had before it goes to publication. It is definitely possible that they will secretly complete that draft and just publish it right away. However, given the NYT article's content, one of the lead authors does not appear to imply that that will be the case.

But only time will tell.

Posted by: dguller at December 19, 2008 04:08 AM
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