“The history of psychiatry is littered with fad diagnoses that in retrospect did far more harm than good,” says doctor Allen Frances, the chairman of the DSM-IV Task Force and current professor emeritus at Duke.
Please to absorb those wise words, spoken by the man who sat in chief on the committee responsible for version four of the well (over?) used Diagnostic and Statistical Manual. I’m tempted to repeat them, not just because of their importance, but because I worry you, dear reader, will pass them by too quickly.
Now read this: “All school children should be screened for risk of mental illnesses such as depression, say leading mental health experts.” This is in England.
Scientists at Cambridge University said they had devised a computer test that could reliably identify those at high risk as early as 11-years-old…
Ian Goodyer, a child and adolescent psychiatrist who worked with Prof Sahakian on the study, said screening 11 to 12-year-old children could reveal those who have ‘low resilience’ – putting them at higher risk of developing mental illnesses such as depression.
However, other experts have warned that labeling someone as ‘high risk’ at such a young age could itself have negative consequences.
Are you comforted that a “computer” will administer these tests? Wow! Computers! Not only is everybody a victim; soon, everybody will be mentally ill. This isn’t just my opinion. Back to Dr Frances:
This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.
The British computerized tests, which will (as do all psychiatrists) rely on the DSM 5, to divide the kiddies into sheep and goats is bound to uncover many children “previously unsuspected” of being “mentally ill” or, as a catch all, “at risk.” The latter means “not mentally ill” but will be interpreted as “could be mentally ill,” and thus worthy of treatment. The words “false positive” will have no meaning. We’ll instead hear “Better safe than sorry.” Put the kids into a program, slip them little green pills, track their behavior and keep records, “just in case.”
Frances says the DSM 5 changes were “vigorously opposed.” But in vain:
More than fifty mental health professional associations petitioned for an outside review of DSM 5 to provide an independent judgment of its supporting evidence and to evaluate the balance between its risks and benefits. Professional journals, the press, and the public also weighed in—expressing widespread astonishment about decisions that sometimes seemed not only to lack scientific support but also to defy common sense…
[The] APA stubbornly refused to sponsor any independent review and has given final approval to the ten reckless and untested ideas that are summarized below.
The Brit docs who would administer the computerized Rorschach (or its modern equivalent) to all children said:
[T]esting children at school age could help health authorities get in early and offer therapy to prevent people descending into more serious, hard to treat conditions.
‘When you think that the burden of mental illness is more than cancer, more than heart disease – so why on earth don’t we try to do something more proactive,’ she said, after presenting her results at a briefing in London.
‘Why are we not doing anything to pick it up early? To me it’s a no-brainer.’
A no-brainer indeed. Oh, the ever-diligent researchers also discovered certain genes “associated with” (i.e. evincing weak statistical correlation) mental diseases. Tissue samples thus must be collected. It’s for the good of the children.
Dr Frances has lots of words on why the DSM V has derailed: mainly, it’s just academics being academics: the love of theory being a disease unrecognized but rife in its pages. Here, anyway, are some of the brand new “diseases” in DSM V.
2) Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life…
4) DSM 5 will likely trigger a fad of Adult Attention Deficit Disorder leading to widespread misuse of stimulant drugs for performance enhancement and recreation and contributing to the already large illegal secondary market in diverted prescription drugs.
5) Excessive eating 12 times in 3 months is no longer just a manifestation of gluttony and the easy availability of really great tasting food. DSM 5 has instead turned it into a psychiatric illness called Binge Eating Disorder…
Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSM’s teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be.
We’ll leave Frances the final word, too: “DSM 5 violates the most sacred (and most frequently ignored) tenet in medicine- First Do No Harm!”
Update From PubMed, journal CMAJ. DSM revision surrounded by controversy. “Dr. Robert Spitzer, editor of DSM-III, has expressed a similar opinion. In 2008, he wrote an open letter criticizing the confidentiality agreement (Psychiatr News 2008; 43:26). In the letter, Spitzer says that he requested the minutes of a DSM-V meeting but was refused.”
HT to Medical Skeptic (@medskep).