Inside the Controversy Over the Bible of Mental Disorder

Dec 11, 2012 Full story: news.yahoo.com 8

The Diagnostic and Statistical Manual of Mental Disorders is "the so-called bible of mental disorders," explains Benedict Carey, who writes of the recent approval of the fifth edition of the manual by the board of trustees of the American Psychiatric Association in a piece in Tuesday's New York Times. While this new manual, DSM-5, won't be released until May of 2013, marking "one of the most anticipated events in the mental health field" according to the American Psychiatric Association website, there's been an air of swirling controversy and drama surrounding the update since it began five years ago. The update process was not, in a word, dull.

Though premenstrual dysphoric disorder, binge-eating, and hoarding are now listed as their own disorder entries, the main controversies were over changes to the diagnoses of depression, autism, and pediatric bipolar disorder. For example, the group working on the depression definition pushed to get rid of the "bereavement exclusion," which stipulates that those coping with the loss of a loved one are not clinically depressed; others argued that the bereaved should not be diagnosed with clinical depression. Carey writes, "In the end the committee cut a deal. It eliminated the grief exclusion but added a note in the text, reminding doctors that any significant loss — of a job, a relationship, a home — could cause depressive symptoms and should be carefully investigated."

As Carey writes of the committees working on the revision: "They plotted a revolution, fell to debating among themselves, and in the end overturned very little except their own expectations" during years of "sometimes acrimonious, and often very public, controversy." The doctors appointed to update the manual, for instance, had taken the responsibility into Web-friendly territory, posting online proposals for changes in definitions (of depression and Asperger syndrome, for example) which the public then weighed in on—patient advocacy groups and outside academic researchers objecting vociferously to certain changes, and several committee members abandoning the work in protest.

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DNF

““Be guided by principles..."”

Since: Apr 07

Baltimore

#1 Dec 11, 2012
FTA:
The revision process was a rather massive undertaking, per the American Psychiatric Association's website: "The last stage of the manual’s development began in late June 2012 at the end of a six-week open-comment period for health professionals, patients and families, advocates and others. Throughout the three open-comment periods, which began in 2010, we have received more than 13,000 comments and more than 12,000 emails and letters from you, our readers." Now, "Changes to disorders and diagnostic criteria, based in part on the latest comments received, will be made through the fall."

Since: Dec 08

Toronto, ON, Canada

#2 Dec 11, 2012
I have always believed I have a modified version of what is/was labeled as Asperger's. I have many of the characteristics but not others.
The whole problem with conditions like these is that people who have characteristics rendering them different but not preventing them from functioning are stigmatized. But there is always some sort of boundary - a child who prefers to be along but is not unhappy probably should not be forced into treatment; a child who is injuring himself by banging his head against the wall probably needs some sort of intervention.
Chance

Grove City, PA

#3 Dec 11, 2012
Absolutely amazing. And they call that science? Diseases of the body are not put before the public with opinion being factored in on whether or not diabetes or leukemia are diseases. It is astonishing that this "bible" is developed with opinion. That explains a lot about homosexuality being removed from the list of disorders, and the psychiatric profession has slipped to new lows in my regard. It is entirely understandable that psychiatry cannot be the exact science that the medical profession is. Unfortunately, however, the psychiatrists and the people who agree with them give them way more power and influence over our society and culture than they apparently deserve.

Since: Mar 09

Location hidden

#4 Dec 11, 2012
Chance wrote:
Absolutely amazing. And they call that science? Diseases of the body are not put before the public with opinion being factored in on whether or not diabetes or leukemia are diseases. It is astonishing that this "bible" is developed with opinion. That explains a lot about homosexuality being removed from the list of disorders, and the psychiatric profession has slipped to new lows in my regard. It is entirely understandable that psychiatry cannot be the exact science that the medical profession is. Unfortunately, however, the psychiatrists and the people who agree with them give them way more power and influence over our society and culture than they apparently deserve.
It's NOT "put before the public". Comment is by professionals only.

DNF

““Be guided by principles..."”

Since: Apr 07

Baltimore

#5 Dec 11, 2012
snyper wrote:
<quoted text>
It's NOT "put before the public". Comment is by professionals only.
"Chance" is one of those people who'd rather not read the article and possibly learn that some of what he thinks he knows is crap.

However there was a period where "The doctors appointed to update the manual, for instance, had taken the responsibility into Web-friendly territory, posting online proposals for changes in definitions (of depression and Asperger syndrome, for example) which the public then weighed in on—patient advocacy groups and outside academic researchers objecting vociferously to certain changes, and several committee members abandoning the work in protest."

What "Chance" seems to forget is there wasn't this type of thing done when homosexuality was declassified as a mental illness. The internet hadn't even been thought of yet.

DNF

““Be guided by principles..."”

Since: Apr 07

Baltimore

#6 Dec 11, 2012
Chance wrote:
Absolutely amazing. And they call that science? Diseases of the body are not put before the public with opinion being factored in on whether or not diabetes or leukemia are diseases. It is astonishing that this "bible" is developed with opinion. That explains a lot about homosexuality being removed from the list of disorders, and the psychiatric profession has slipped to new lows in my regard. It is entirely understandable that psychiatry cannot be the exact science that the medical profession is. Unfortunately, however, the psychiatrists and the people who agree with them give them way more power and influence over our society and culture than they apparently deserve.
The idea of mental illness being a disease of the body wasn't that widely held until the last half century and even then it was often met with skepticism by the general public.

It's also important if people understand how science defines a disease versus a syndrome.

A disease has an accepted cause. Causes of syndromes are not known which is part of why they classify it as a syndrome and not a disease.

A disease has known verifiable treatments. Treatments for syndromes are mostly guesswork; trial and error.

Since: Mar 09

Location hidden

#7 Dec 12, 2012
DNF wrote:
<quoted text>"Chance" is one of those people who'd rather not read the article and possibly learn that some of what he thinks he knows is crap.
However there was a period where "The doctors appointed to update the manual, for instance, had taken the responsibility into Web-friendly territory, posting online proposals for changes in definitions (of depression and Asperger syndrome, for example) which the public then weighed in on—patient advocacy groups and outside academic researchers objecting vociferously to certain changes, and several committee members abandoning the work in protest."
What "Chance" seems to forget is there wasn't this type of thing done when homosexuality was declassified as a mental illness. The internet hadn't even been thought of yet.
Advisory committees and public input really have little to do with the final result, though it certainly appears at first blush that the process is being politicized to some degree.

Input from those afflicted IS a growing trend throughout the discipline, and it is viewed as preferable to the dogmatic pronouncements of the freudian past.

Still, it is the data of the researchers first, clinicians second and patients/others third.

DNF

““Be guided by principles..."”

Since: Apr 07

Baltimore

#8 Dec 12, 2012
snyper wrote:
<quoted text>
Advisory committees and public input really have little to do with the final result, though it certainly appears at first blush that the process is being politicized to some degree.
Input from those afflicted IS a growing trend throughout the discipline, and it is viewed as preferable to the dogmatic pronouncements of the freudian past.
Still, it is the data of the researchers first, clinicians second and patients/others third.
Agreed. Thanks for making those points.

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