Tag Archives: American Psychiatric Association

Shrinks on the couch as they ponder who is and is not crazy

SOME psychiatrists — the ones who don’t believe they are godlike creatures — are in a bit of a tizz these days. They are worried about all the damage they might have unwittingly done by misdiagnosing mental illness. Libyan leader Colonel Muammar Gaddafi could help to ease their furrowed brows. Some background, before I explain that apparent non-sequitur: In a soul-searching analysis of his profession in Wired magazine recently, US psychiatrist Dr Allen Frances declares that mental disorders “can’t be defined”, and it’s “bull—-” to suggest otherwise. Frances is lead editor of the DSM-IV, the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual. It’s a publication that has been described as “the bible” and “the imperial doctrine” of psychiatrists.

It’s what shrinks use, in their godlike wisdom, to decide whether or not you are mentally ill — and then to prescribe powerful, dangerous drugs, and other treatments that can turn you into a shadow of your former self. In the gut-wrenching Wired article, Frances says: “We psychiatrists have made mistakes that had terrible consequences.”

American Psychiatric Association’s Interests in Conflict

At the annual American Psychiatric Association meeting in New Orleans this summer, 200 protestors chanted “no conflicts of interest” and held up photos of individual doctors outside the convention center. Inside the hall, their charges were verified. The meeting’s Daily Bulletin disclosed that the APA president himself, Alan Schatzberg, has 15 links to drug companies including stock ownership and serving on a speakers bureau. Doctors on other speaker bureaus like Shire’s Ann Childress and Wyeth’s Claudio Soares gave presentations and workshops that — surprise! — extolled company drugs. And signing books, side by side, was the duo now accused of penning an entire book for the drug industry: Alan Schatzberg and Charles Nemeroff.

This month ProPublica and the New York Times report that Schatzberg and Nemeroff’s book, Recognition and Treatment of Psychiatric Disorders: A Pharmacology Handbook for Primary Care, may be the first entirely drug industry-approved textbook ever. Published in 1999, the book’s preface says it was funded by an unrestricted education grant to Scientific Therapeutics Information through London-based GlaxoSmithKline (GSK). Scientific Therapeutics Information of Springfield, NJ is the same medical publishing company that spun Vioxx.

What’s A Mental Disorder? Even Experts Can’t Agree

The American Psychiatric Association’s Diagnostic and Statistical Manual, or DSM, updated roughly every 15 years, has detailed descriptions of all the mental disorders officially recognized by psychiatry. It’s used by psychiatrists, insurance companies, drug researchers, the courts and even schools.

But it’s not without controversy: The proposed changes suggested this year have sparked a kind of civil war within psychiatry.

In a small condo on the beach in San Diego lives Allen Frances, who blames himself for what he calls the “Epidemic of Asperger’s.” Frances edited the last edition of the DSM, and he’s also the new DSM’s most prominent critic. Frances is the one who put the word Asperger’s in the DSM in the first place, thereby making it an official mental disorder

Electroconvulsive Therapy: Will The FDA Whitewash It?

For decades the FDA has allowed electroconvulsive therapy (ECT) to be used without requiring any proof of safety or efficacy. The machines and the treatment has been “grandfathered” into use rather than tested. A few years ago the FDA proposed to test the treatment but heavy pressure from the American Psychiatric Association caused the agency to reverse itself. ECT remains untested and widely used. Imagine that — the American Psychiatric Association doesn’t want an obviously dangerous treatment to be tested at all. It just wants psychiatrists left alone to inflict it upon hapless patients. The sad truth is that psychiatry has always promoted brain-damaging treatments, including lobotomy, electroshock and toxic chemical substances. In the 1970s I conducted an intensive international campaign to stop the resurgence of lobotomy and others forms of psychosurgery, and if my campaign had not been successful, lobotomy would have once again become widely accepted within contemporary psychiatry. Using media citations and other sources, that campaign and its success is documented in The Conscience of Psychiatry: The Reform Work of Peter R. Breggin, MD.

DSM: The Book of Woe—Inside the Battle to Define Mental Illness

Every so often Al Frances says something that seems to surprise even him. Just now, for instance, in the predawn darkness of his comfortable, rambling home in Carmel, California, he has broken off his exercise routine to declare that “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.”

The insurgency against the DSM-5 (the APA has decided to shed the Roman numerals) has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.”