DSM

While a great deal of the excitement about advances in psychological treatments comes from the potential for research in neuroscience to unlock the secrets of the brain, many mental health experts would like to temper this enthusiasm. A special issue of the Behavior Therapist released this month calls into question the predominant conception of mental illnesses as brain disorders.

The American Journal of Psychiatry (January, 2103) recently published a series of articles that analyzed the outcomes of the field trials that were conducted by the DSM-5 Task Force, to determine the inter-rater reliability of the multiple diagnostic categories that will comprise the DSM-5. A table below tracks the downward progression of inter-rater reliability from DSM-III through DSM-5.

In just two decades, pointing out the pseudoscience of the DSM has gone from being an “extremist slur of radical anti-psychiatrists” to a mainstream proposition from the former chairs of both the DSM-3 and DSM-4 taskforces and the director of NIMH. In addition to the pathologizing of normal behaviors, another explanation for the epidemic — the adverse effects of psychiatric medications — is also evolving from radical to mainstream, thanks primarily to the efforts of Robert Whitaker and his book Anatomy of an Epidemic. While diagnostic expansionism and Big Pharma certainly deserve a large share of the blame for this epidemic, there is another reason.

More than a year on from the release of DSM-5, a Medscape survey found that just under half of clinicians had switched to using the new manual. Most non-users cited practical reasons, typically explaining that the health care system where they work has not yet changed over to the DSM-5. Many, however, said that they had concerns about the reliability of the DSM, which at least partially accounted for their non-use. Throughout the controversies that surrounded the development and launch of the DSM-5 reliability has been a contested issue: the APA has insisted that the DSM-5 is very reliable, others have expressed doubts. Here I reconsider the issues: What is reliability? Does it matter? What did the DSM-5 field trials show?

Researchers detect disparity between white and African American patients diagnosed with schizophrenia when symptoms of a mood disorder are present.

Amid calls for a retraction, Lancet Psychiatry publishes articles criticizing the original finding and a response from the authors.

Neuroscience researchers find no differences in brain connectivity between children with diagnoses of autism, ADHD, and those with no diagnoses.

A new article suggests counselors and psychotherapists are dissatisfied with current diagnostic systems and outlines some potential alternatives.

A new analysis of the information that the National Institute of Mental Health (NIMH) publishes for parents about attention deficit hyperactivity disorder (ADHD) concludes that the children’s experiences and contexts are ignored and that medication is presented, misleadingly, as the only solution supported by research evidence.

Revealing the false information provided about psychiatry should cause any thinking person, patient, thought-leader or politician to wonder: “how many otherwise normal or potentially curable people over the last half century of psych drug propaganda have actually been mis-labeled as mentally ill (and then mis-treated) and sent down the convoluted path of therapeutic misadventures – heading toward oblivion?”

In recent months, two teams of researchers in the UK and the US published complementary findings about the epigenetic origins of schizophrenia that have scientific communities who indulge in ‘genetic conspiracy theories’ abuzz. While these results are intriguing, and no doubt involve pathbreaking research methodologies, this line of thought represents a decontextualized understanding both of the symptoms that are typically associated with schizophrenia, and their causes.

The latest issue of the journal Behavioral and Brain Sciences features several prominent researchers arguing that mental health concerns are not “brain disorders.”

‘Diagnosing’ someone with a devastating label such as ‘schizophrenia’ or ‘personality disorder’ is one of the most damaging things one human being can do to another. Re-defining someone’s reality for them is the most insidious and the most devastating form of power we can use. It may be done with the best of intentions, but it is wrong - scientifically, professionally, and ethically. The DSM debate presents us with a unique opportunity to put some of this right, by working with service users towards a more helpful understanding of how and why they come to experience extreme forms of emotional distress.

Dr. Raskin discusses psychotherapists’ dissatisfaction with current psychiatric diagnostic systems and explores alternatives.

In a new report, the United Nations Special Rapporteur on the right to health, Dr. Dainius Pūras, calls for a move away from the biomedical model and “excessive use of psychotropic medicines.”

The team that developed the Power Threat Meaning framework as a diagnostic alternative reflects on the response to the framework after one year.

-A special issue of Public Affairs Quarterly examines "the moral and political implications" of the Diagnostic and Statistical Manual of Mental Disorders.

Criticisms of the DSM-5 spark alternative proposals and calls to reform diagnostic systems in the mental health field.

A case analysis of an American Indian woman illustrates how the DSM diagnostic criteria misrepresent the lives of indigenous people.

Kev Harding argues against conceptualizations of therapy as a ‘cure’ to an ‘illness’ and instead offers alternative approaches.

In my last post, I argued that the single most damaging effect of psychiatric diagnosis is loss of meaning. By ruthlessly divesting experiences of their personal, social and cultural significance, diagnosis turns ‘people with problems’ into ‘patients with illnesses.’ Horrifying stories of trauma, abuse, discrimination and deprivation are sealed off behind a pseudo-medical label as the individual is launched on what is often a lifelong journey of disability, exclusion and despair.

The safety of our children is a sacred obligation we strive to preserve. Anything or anyone that harms them becomes the object of our...

Robert Whitaker notes on Al Jazeera's "Inside Story" that a helpful diagnostic text must be both reliable and valid, and the DSM is neither...

For the last three years, I have been working with people, labeled "hoarders," who have become overwhelmed by their possessions in their homes. This has been some of the most interesting, challenging and thought-provoking work I have ever done. It is also an area that, I think, highlights all of the issues that challenge us in helping people who feel overwhelmed, for whatever reason.

Why all the fuss over DSM-5? Why did Robert Spitzer, the editor of DSM-III, begin to protest about the “secrecy” surrounding its production as early as 2007? Why did Allen Frances, editor of DSM-IV, begin in 2009 to challenge the American Psychiatric Association’s (APA) announced goal that when making DSM-5 “everything is on the table”? Why did he dispute the APA’s position that there had been enough progress in neuroscience to call for a “paradigm shift”, and why did Frances and others go on to protest repeatedly what they viewed as DSM-5’s “medicalization of normality?”