There has been a great deal of controversy already about DSM5 and it isn't scheduled to be published until May 2013! So, what's up with that?
You may have heard of some of the controversy surrounding the new edition of the DSM, the "psychiatric bible," published periodically by the American Psychiatric Association. It is the "go to" document that defines all mental health disorders and is used for diagnosis, treatment approaches, and perhaps most especially, for insurance coverage and reimbursement for professional psychiatric services. If you are a mental health professional or a patient of a mental health professional, this is an important document.
In a nutshell, the controversy is centered on several important themes. First, more and more diagnoses are being offered (and the criteria for many disorders has been lowered) so that it appears that there is a mental disorder now available for everyone. Second, the continued and expanded emphasis on biological causes for problems in living implies that medications are the solutions to most of life troubles. Third, many of the changes do not appear to be supported by the professional scientific and peer reviewed research literature. Finally, and perhaps most concerning, is the notion that the changes are a further demonstration that psychiatry's too comfy relationship with the pharmaceutical industry make the whole effort a potential sham and thus
politics, money, and conflicts of interest rule the day rather than science and best clinical practices. Thus, the American Psychiatric Association may be creating an influential document that enriches their profession and guild that could be actually cloaked in pseudoscience and self interest. Sacred scripture it is not.
One of the divisions of the American Psychological Association has started a petition about these concerns with the DSM. Several Psychology Today bloggers have discussed it from various angles in the past week. If interested you can read about the petition (and sign it if you wish) using the following link: http://www.ipetitions.com/petition/dsm5/?utm_medium=social&utm_source=facebook&utm_campaign=button
You might wonder why this controversy should matter to you. If you have little to do with the psychiatric profession (either as a practitioner or patient) why should you care? I think that the most important concern is that the use of psychotropic medications, which certainly have their place in treating a variety of serious emotional and behavioral problems, has recently proliferated to remarkable levels. The use of antidepressants, for example, has been reported to be used by more than 10% of the entire American population, has grown by over 400% in the past decade and a half, and is the number
one medication administered to young people. College students routinely take the various
ADHD drugs, which are very easy to obtain, to help them study during exams. We have developed a culture where a medication is the first solution to so many problems in living. There are many unintended consequences as well. For example, recent research from Stanford found that increases in
autism rates are related to women taking anti-depressant medications during the first trimester of their
pregnancy. Research has also found that these medications may make teens more vulnerable to
suicide. ADHD meds are being sold rountinely on college campuses during exam periods.
The
ethics of DSM5 can be discussed from many different angles...too many to detail in a brief blog post. But perhaps the most important one in my mind is the concern for the welfare of others that avoids conflict of interests. Those professionals, such as psychiatrists who have responsibility and authority in the lives of others (especially among those who are the most vulnerable such as children, the elderly, and the psychiatrically compromised), really must have their patient's welfare and best interests in mind. Guild and financial issues must always take a back seat to what is most important in helping real people with real problems. Concern for the welfare of others while using the very best that science and best practices have to offer is critical in order for us to have any
faith in the helping and healing professions.
The bottom line? Simply put, if DSM5 does
not reflect the very best state-of-the-art science of psychiatry, psychology, and human behavior and if it is influenced by guild and financial incentives then it is an immoral and unethical document and the American Psychiatric Association should be ashamed of themselves. In this case, they likely drank the Big Pharma Kool Aid. However, if the document
is indeed based on objective and quality science and is
not influenced by guild and financial issues then it should be embraced fully by professionals and patients alike and the American Psychiatric Association should be thanked and praised.
So, what do you think? What do you think are the ethics of DSM-5? Is it sacred scripture? Does it help or hurt people? Should the American Psychiatric Association be praised or dammed?
