Furious Seasons

June 25, 2009

Psychiatrists Attacking Psychiatrists For Blogging On Disclosure Controversies

There are a few bits of news in this post but they are tough to organize: suffice to say that the politics around the forthcoming DSM-V are becoming very intense and nasty and, slightly connected, psychiatrist-bloggers Doug Bremner (Emory University) and Danny Carlat (Tufts University) are drawing the ire of some colleagues for writing honestly about psychiatry's epic conflict-of-interest problems, earning both a marginalization campaign from others in psychiatry. Yes, it is getting ugly out there.

First, Bremner notes an in-press article at Psychiatric Times by Allen Frances, a psychiatrist who chaired the DSM-IV committee, is deeply critical of the deeply secretive DSM-V process and delivers a stern assessment of the process, the kind that might embiggen the heart of an anti-psychiatrist (article obtainable at Bremner's site):

"The work on DSM-5 has, so far, displayed an unhappy combination of soaring ambition and remarkably weak methodology."

Bremner summarizes further:

"[Frances] then goes on to explode the statements by Kupfer that the DSM-5 will lead to a 'paradigm shift' in psychiatry, which he describes as an 'absurd statement' based on the fact that there still is not a single lab test for diagnosis, and the gains are small and incremental in descriptive research. In the absence of evidence, changes in diagnostic criteria are arbitrary and often driven by a single strong member of the sub-committees. Furthermore, the incorporation of sub-threshold diagnoses as official psychiatric diagnoses will be a 'bonanza' for drug companies who will expand their markets to new legions of the 'newly' mentally ill and rush to 'educate' doctors about the new criteria, which they will use to expand drug usage. It will also serve to expand stigma."

I agree with Frances' points. I've made similar points before and, of course, when I've noted the incrementalism of bipolar disorder type 2 and how it created a new, mostly unnecessary market for pharma companies, I've taken a thorough drubbing. So it's nice to see that Frances, by implication, has my back on some of this.

Bremner himself has created a "Shadow DSM Team" to track the new DSM. This seems to have landed him in some hot water with colleagues, as a post he wrote last month on proposed Developmental Trauma Disorder in children mentioned that some involved in developing possible criteria for the disorder came from institutions (Brown, Dartmouth) with huge conflict-of-interest problems. For this Bremner is paying a price:

"I got an email from someone on the DSM Anxiety, OCD, PTSD and Dissociative Disorders committee whom I thought was a 'friend' un-inviting me to be an author on a paper about another topic (that was after I had already spent several days working on the paper)."

There's some nice revenge. What's interesting is that Bremner has always written about Emory's many conflict of interest problems and that seems to have PO'd some at that school who then used a long-ago Bremner post (part serious, part satirical) about my smoking and losing my housing over the same to demand that Bremner disassociate his blog from the fair, driven-snow reputation of Emory. That's how lame it's getting out there in academic psychiatry.

It gets lamer still. Danny Carlat reports on his blog that some folks within the American Psychiatric Association are trying to keep him off a guidelines review committee over a comment someone left on his blog earlier going after Stanford's Alan Schatzberg, who recently became president of the APA. Read his post for the details.

I know that Bremner and Carlat are both disturbed by the academic snubbing from their colleagues and I imagine their surprise is large as well since the two are moderate critics within their field, mostly of conflicts of interest and rampant pharma-funding of continuing education. I say they should wear their shunning as a badge of honor and realize just how deeply out of touch with reality some of their colleagues seem to be.

Perhaps we can come up with a new disorder in DSM-V to describe the condition.

Posted by Philip Dawdy at June 25, 2009 12:03 AM

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Comments

I guess when it comes to psychiatrists being paid off by pharma and wanting to protect their money, it's a nasty, no holds barred affair. Perhaps there should be a new diagnosis called "delusional psychiatrist disorder" for those many, many psychiatrists who delude themselves into thinking that they can be paid thousands by pharma and continue to remain absolutely objective. The treatment for this disorder should be high doses of Seroquel for the remainder of their lives. Several courses of ECT as an adjunct if the Seroquel doesn't bring them out of their delusional states.

Posted by: Ann at June 24, 2009 11:38 PM

The human condition should ever not be for sale .
But I'm sure the psychiatrist-pharmaceutical marketing manual of the DSM will still make them a "killing".

Posted by: truthman30 at June 25, 2009 02:36 AM

Why don't they just publish the fucking thing instead of rabbitting on about it. It's been such a ridiculously long time coming as it is
%-/...

Posted by: Gledwood at June 25, 2009 07:42 AM

... the DSM 5 I mean, of course

Posted by: Gledwood at June 25, 2009 07:43 AM

Peace be with you Philip

"Paradigm shift" is mental health newspeak. It is like "best practice" or "evidence based." I first ran across that term when I read "Strategies for Reducing Chronic Street Homelessness" (http://www.urban.org/publications/1000775.html). In it the Urban Institute talks about using a "trigger event" as a catalyst for the "paradigm shift." It's results are explained in Naomi Klein's "Shock Doctrine."

I am pretty sure the delusions that your a scientist or a doctor when really your not is already in the DSM (schizophrenia). The delusion that you are superior and know what strangers "need" despite the stranger's own opinions is in there too (Narcissistic personality disorder). To add another "disorder" for an obviously sick group of people is a bit redundant. What we need is a new entry to the penal codes about these practices.

love eternal
tad

Posted by: tad at June 25, 2009 07:54 AM

As with the FDA approval of pharmaceuticals, the DSM process should not be secretive. The manual determines reimbursements and treatment regimen. I’m still trying to figure out how exactly the DSM folks have the ability to add and delete what were previously determined to be mental disorders? Is this interior decorating, or medicine?

I’m a novice, and I think highly of any mental health expert who challenge and criticizes the formation of the DSM. They realize that there is much at stake here, and that life is not a popularity contest:

The Diagnostics and Statistical Manual (DSM), the Shrink's bible, has been around for over 50 years. Within this manual, there are now possibly nearly 300 mental disorders.

The latest DSM, the DSM IV, was made available in 1994. The next DSM V expects to have its first draft finished by the end of 2010- and those involved with its creation speculate that the DSM V be published in 2012.

As a thorough dictionary of suspected mental illnesses, many redefined or recognized diagnoses are added to this manual with each edition often. This is particularly the case if medicinal therapy exists as a treatment option for certain mental illnesses.

On occasion, a mental disorder is deleted from the DSM, such as homosexuality in the early 1970s.

Its purpose, this manual, is to assist mental health professionals to diagnose and classify mental disorders.

Published and designed by the American Psychiatric Association (APA), the DSM is also used, I understand, for seeking mental diagnostic criteria to assure reimbursement.

The DSM is organized partially by the following:

I- Mental disorders
II- mental conditions
III- Physical disorders/syndromes, medical conditions (co-morbidity)
IV- Mental disorder suspected etiology
V- Pediatric assessments

The APA has historically directed the creation of each edition of the DSM, and assigns selected task force members to create this manual. This situation has proven to be controversial.

The next DSM involves 27 people. About 80 percent of these individuals are male, and less than 5 members are not medical doctors. Most have had relationships with the NIH, and about 25 percent of these task force members have had relationships with the WHO.

Historically, at least a third of task force members have had, or do, have often monetary pharmaceutical industry ties in some way. Presently, greater than fifty percent of the task members have pharmaceutical industry ties.

This makes sense, as one considers that about one third of the APAs total financing is from the pharmaceutical industry.

The APA required this task force for the next DSM edition to sign non-disclosure agreements- which is rather absurd and pointless. Lack of transparency equals lack of credibility because of these agreements of the content of the next DSM. It opposes any recovery model necessary regarding such disorders, I believe.

The DSM should be evaluated by another unrelated task force or a peer review of sorts to assure objectivity. This is particularly of concern presently, as many more are diagnosed with mental dysfunctions presently at a concerning rate- with very young children in particular.

www.dsm5.org

Dan Abshear

Posted by: Dan at June 25, 2009 08:29 PM