Last week I challenged APA to end its silence in the face of widespread criticism and finally to mount its belated public defense of DSM 5. These are the five questions that cry out for straight answers:
1) Why is APA not willing to have an independent scientific review of questionable DSM 5 proposals—especially since its own internal and confidential review process has been so badly discredited?
2) Since the DSM 5 suggestions will all broaden the definition of mental disorder, why should we not worry about diagnostic inflation and the massive mislabeling of normal people as mentally ill?
3) Won't this diagnostic inflation exacerbate the already rampant over prescription of psychotropic medications (especially by primary care doctors, especially antipsychotics, especially to kids)?
4) Why should we not worry about the unintended forensic complications of a sloppily written DSM 5 containing suggestions that are obvious targets for forensic misuse?
5) Won't the many small, needless, and arbitrary changes in DSM 5 complicate future research efforts and make impossible the interpretation of data collected before vs after DSM 5?
The first public APA response to the concerns about DSM 5 is truly astounding in its carelessness and inaccuracy- a sad marker of the failed process that is DSM 5. The APA letter got off to a strange start by with the wrong date—it was originally dated Oct 4 not Nov 4 (this has since been corrected in the current posted version, but the glaring proof reading slip is worrisome for a manual requires the precision of a legal document). The letter ended with an equally strange sign off—by the 'DSM 5 Task Force' (are there no individuals willing to stand up and be counted for DSM 5?). In between this muddled beginning and sheepish ending, the APA Apologia completely ignores all five of the crucial concerns about DSM 5 safety and credibility and instead provides a compendium of misleading statements and blatant inaccuracies. Here is just a sampling:
1) APA stresses that final decisions await the completion of the field trials belatedly being conducted at academic centers—as if the results will in some way be a contributory check on bad ideas. But these field trials have been disorganized and misdirected—their data will be terribly late in coming and totally irrelevant to the concerns about diagnostic inflation and misdiagnosis that are raised in the petition. For no apparent reason, the field trials address only the (really who cares) question of reliability—and will offer nothing at all on the (really essential) questions of validity and predicting the risks of diagnostic inflation.
2) APA promises that the clinician field trial data will "contribute to the final decision making.". How can this possibly be true when the clinician field trial is (as with everything DSM 5) so disorganized and far behind schedule that it is just now getting underway?
3) APA makes the truly bizarre (and Orwellian 'newspeak') claim that its "level of both internal and external review and field trial exposure has never before been undertaken by any previous DSM or ICD revision proposals." The simple fact is that DSM 5 has been shrouded in secrecy from
its original confidentiality contracts that gagged DSM 5 work group members to its current confidential scientific review- as if anything claiming the name of science should ever be kept secret. DSM 5 has been unable to self correct and is remarkably resistant to correction from without. Its current draft suggestions are for the most part essentially the same as the flawed and poorly written drafts first posted in Feb 2010. Vigorous public criticism has obviously had virtually no impact on the hermetically sealed DSM 5 process.
It is clearly incumbent on APA to allay the many outstanding concerns raised by the petition with straightforward and credible answers—public relations pablum simply will not cut it. If DSM 5 fails to conduct a serious dialog with its users, there will no reason for them to trust or buy it. Clinicians (and their patients) would be better served by their simply downloading the official ICD-10-CM codes which will be freely available on the internet. The Petition To Reform DSM 5 is the only way to force APA to subject DSM 5 to the independent, external, scientific review that is essential for a safe DSM 5.
The petition is available for signing at: http://www.ipetitions.com/petition/dsm5/
The APA response to the petition is at: http://www.dsm5.org/Newsroom/Documents/DSM5%20TF%20Response_Socie...
The Petition's response back to APA is at: