The DSM-5 is only a dead sea scroll and not the fully approved Allen Frances version

I hear a constant buzzing. No, wait. It’s only Allen Frances.

The chief editor of the DSM-IV is posing as the chief critic of the DSM-5, if that makes any sense. The problem is that the criticisms this retired psychiatry professor applies to the DSM-5 apply to the DSM-IV as much as they do to anything, and I’m still waiting for a major display of remorse over that document.

If we look at his latest in a catalogue of complaints against the upcoming DSM revision, DSM-5 Is A Guide, Not A Bible—Simply Ignore Its 10 Worst Changes, some of his criticisms are right on target.

His numero uno is a real humdinger, Disruptive Mood Dysregulation Disorder (DMDD) or temper tantrum disorder. This is the DSM revision teams way to try to deal with an artificially created epidemic that isn’t even in the DSM. A Harvard psychiatrist developed this notion that a number of these kids diagnosed ADHD were actually bipolar, and thus began the pediatric bipolar disorder boom. The DSM revision team has simply created a third diagnosis with which to compound the prior two diagnoses. When ADHD and bipolar disorder are at epidemic proportions, this is certainly paving the way for a third wave. Just wait, perhaps in 10 or 20 years they will come up with an adult DMDD diagnosis.

His second and ninth complaints we can skip over. Sadness, grief, and anxiety aren’t illnesses, or diseases, or disorders, or whatever you want to call them. They are emotions known to all of us. The distinction between clinical and “normal” is a distinction between the everyday and the psychiatrized. If you want one, go about your business, it will come. If you want the other, see a shrink. He or she has their “help” to contribute.

Number 3 is Neurocognitive Disorder or old folks disease. Oh, yeah. Age happens to everybody. I kind of think it redundant as when the brain breaks you have dementia or Alzheimer’s. If we had a ready trash can we could scrap number 3, too, but, of course, psychiatrists must to make a…I dunno…Is it a living, or is it a killing? Anyway, it’s bread, bacon, and a big house in an upscale neighborhood.

Number 4 is adult ADHD. I think I covered the subject sufficiently with number 1. There was a time when there was absolutely no ADHD. A few unruly children popped up, and the editors of the DSM-III put it in the DSM. ADHD babies grow up. 30 years on and, it’s epidemic among children, while the revisers of the upcoming edition are making it an adult “disease”. Pill popping babies grow up to be pill popping adults. Although the drug companies know this, they aren’t letting on. Why nip a good thing in the bud.

Number 5 over eating isn’t a disorder any more than over drinking is a disorder. Alcohol poisoning, with attendant headaches, on the other hand, bellyaches, diarrhea, and vomit, are major concerns. If you’re going to over indulge, learn to under indulge, er, or moderate your appetites. If you need a shrink to do so, well, you’re probably pretty gullible when it comes to a number of these other disorders. Excess in anything could be “co-occurring”, lay talk for “co-morbid”, with any human trait, negatively labeled a disorder, under the sun, moon, and stars. Psychiatrists tend to think “mental disorders” lead to “substance abuse” and vice versa. What a racket!

His complaint number 6 is a little weird coming from a psychiatrist. This has to do with the switch from Autism and autism related disorders to a general Autism Spectrum Disorder.

School services should be tied more to educational need, less to a controversial psychiatric diagnosis created for clinical (not educational) purposes and whose rate is so sensitive to small changes in definition and assessment.

Alright. Should you be talking to the nation’s shrinks or the nation’s educators on this score, and then how does this effect other controversial juvenile diagnoses (say, ADHD, conduct disorder, etc.)? If your talking about the collusion between this nation’s educators, law enforcement officers, government officials, mental health workers and psychiatrists that is an even bigger issue than we’ve got time to cover right here and now.

Number 7 is certainly a valid complaint, and number 8 follows close behind. If recreational illicit substance use is abuse, habit and indulgence equals abuse, too. Although hypersexuality was not included in the upcoming revision, internet addiction is going to be there, and internet addiction is a behavioral addiction. Behavioral addiction opens up the flood gates for any fad or trend to be classified an addiction. If internet addiction makes this edition, you can bet other behavioral addictions are coming, and sexual addiction, however you spell it, is way up there at the top among the candidates for inclusions in future editions.

What he ignores is that these “worst changes”, as he puts it, are the result of a process and an idea that is thoroughly unscientific from beginning to end. You don’t find real diseases by inventing them, and voting them into common parlance. You only find fanciful diseases that way.

DSM-5 violates the most sacred (and most frequently ignored) tenet in medicine—First Do No Harm! That’s why this is such a sad moment.

We, in the psychiatric survivors movement, have been something similar for decades. What follows from this sacred tenet is my next question directed at Professor Frances. Why, given this basic tenet, do you need a guide book for doing harm to people at all?

This harm starts with the psychiatric label. The label is a category in the DSM. All further harm follows from this labeling of human beings as flawed or pathologically affected or unworthy. This labeling represents the beginning of a downward slide in perception from discourse between equals to that of discourse between designated authorities and sub-human second class citizens. Even if you’re using a bamboo pole and string rather than a rod and reel, a few of us still aren’t taking the bait.

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2 Responses

  1. Great post!

    There is much, much, much more going on here – with the release of DSM-IV or DSM-V texts – than a desire to help people. First do no harm requires a certain restraint of behavior that we’re just not seeing anymore.

    There’s an overzealousness, over-caffeinated-ness, for labeling people with psychiatric disorders, and serving up treatments for them, and a major lack of reflection about the damaging effects of these actions.

    • Thanks, Orion.

      Often the last person who’s interests are considered in a treatment context are the patient’s interests. I think it important when looking at the role psychiatry performs to look at the function of psychiatry, and who it benefits. When the patient’s interests are not considered, the patient is not the person who benefits. Where the patient doesn’t benefit, the patient is harmed. Of course, I’m speaking in relative terms here. There is injury done to a person’s body, and then there is injury done to a person’s interests. Although related, they are not always synonymous.

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