Science Isn't Golden

Correction to Dr. Caplan's blog:
Dear Dr. Caplan,
I am pleased that you are raising awareness about the potential harm of the proposed DSM-5. However, I am writing to ask that you please correct your statement that implies that my committee and I are not concerned about adults. I was taken aback that you would make that statement. As you know, my committee and I are deeply concerned that the DSM-5 could be harmful to vulnerable populations such as young children, adolescents, and the elderly (which are already being given inappropriate diagnoses and treated with psychiatric drugs). However, when we raise special concern about these highly vulnerable populations, this does not mean that we are somehow not also concerned about others. I'm not sure why you would conclude such as it really doesn't make sense. So please make this correction.
So I respectfully ask that you make this correction. I would not have written except, as you know, my committee and I are leading a major effort in the U.S. and Europe to bring about changes in the DSM-5 before it is published in 2013. So your mistake could hurt this important effort. We ask readers to go directly to our petition website that more than 9000 mental health professionals have signed and read the "Open Letter" which is the scholarly and scientific expression of our concerns. The URL is: http://www.ipetitions.com/petition/dsm5/
Readers might also wish to watch our brief You/Tube video which focuses on the "social justice" issue of vulnerable populations. The video at:
http://www.youtube.com/watch?v=rwRwqhhWh3o
Thank you for making this important correction and we wish you the very best in your efforts.
David N. Elkins, PhD, Chair of the Open Letter Committee and President of Division 32, Society for Humanistic Psychology, American Psychological Association.

Hello Paula,
Just to clarify: My committee and I support all efforts to raise awareness about the proposed DSM-5. However, we have our own carefully worked out approach, which focuses on mental health professionals and the scholarly/scientific concerns about the DSM-5 as currently proposed. (We also support any legitimate public petition and would love to see someone lead such an effort but we can only do so much ourselves and our focus has been on mental health professionals). As you indicated, Dr. Allen Frances who was Chair of the DSM-IV Task Force, along with other influential mental health professionals, has indeed encouraged many professionals to sign our Open Letter and we are grateful for this, but Dr. Frances is not on our committee. Our committee is composed of members of the Division 32 Board -- people that I have appointed to help with this effort. We are fortunate to have on the committee major leaders in the field of psychology including a former president of the American Psychological Association and a former reporter for CNN who has helped us immensely with news organizations and other media. I also appreciate very much your efforts to let readers know about the potential harm that DSM-5 could cause; but I did want to clarify and correct a couple of things in your response. Sincerely, David N. Elkins, Chair of the Open Letter Committee, President, Div. 32, Society for Humanistic Psychology, American Psychological Association

Paula, your comments are particularly welcomed by the queer community whom you have supported in the past (and we thank you!).

It is now an open secret that Trangenderism etc (transsexualism, gender identity personality disorder, gender dysphoria, tranvestism, call it what you will, a rose by any name) will continue to be major metal illnesses in the DSM-5 despite powerful contrary evidence. Bad as things are for transgender, transsexual people in DSM-IV they are expected to be even more damaging in DSM-5, most notably for physically intersex people.

And, an even more important open secret, is that they will be given non-pathologising classifications (like being a victim of rape) in the ICD-11. This is in response to calls from the European Parliament and from the Health Ministries of individual countries to the WHO to so reclassify. Any move away from DSM towards ICD will help queer people, and the sooner the better.

Having said that, I am not convinced about a pledge not to buy the DSM because practitioners cannot look into the future. I truly believe that a pledge to use the ICD in preference to the DSM wherever possible would be preferable instead. Could I implore you to restart that particular petition while it is still young?

Thank you for the kind words. If you will look at all that was written on the Boycott the DSM petition and notes, you will see that I address that there. The fact is, though, that both the ICD and DSM can be found online at no charge. And perhaps you can help us determine what happens to the money that the World Health Organization makes from selling the ICD. We know that the profits from the DSM go to the American Psychiatric Association, which is a lobby group. I hope that WHO uses its profits from the ICD for better purposes. What the PLAN T Alliance is fundamentally about is stopping the use of psychiatric diagnoses, whether they appear in an official manual or not. You might want to consider joining the Alliance. Let me know.

> perhaps you can help us determine what happens to the money that the World Health Organization makes from selling the ICD ...

Put simply, I don't know and I'm not convinced there are any profits. WHO is, of course, part of the United Nations Organisation (sic) and any monies are decided by international treaty between governments.

If you really want to know then I suggest writing to ask (airmail, not email) to Helena Nygen-Krug, Health and Human Rights Adviser, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Or, if you have FAX facilities you can FAX to her at + 41 22 791 31 11. For the USA the "+" on international telephone numbers is 011

I hope I don't need to say that any query must be focused and include appropriate background information if a useful answer is to be expected. Remember these people will not have your context, they are bureaucrats at heart :-)

I would suggest writing to make TGEU (Transgender Europe) aware of your Alliance. See http://www.tgeu.org/

> perhaps you can help us determine what happens to the money that the World Health Organization makes from selling the ICD ...

Put simply, I don't know and I'm not convinced there are any profits. WHO is, of course, part of the United Nations Organisation (sic) and any monies are decided by international treaty between governments.

If you really want to know then I suggest writing to ask (airmail, not email) to Helena Nygen-Krug, Health and Human Rights Adviser, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland

Or, if you have FAX facilities you can FAX to her at + 41 22 791 31 11. For the USA the "+" on international telephone numbers is 011

I hope I don't need to say that any query must be focused and include appropriate background information if a useful answer is to be expected. Remember these people will not have your context, they are bureaucrats at heart :-)

I would suggest writing to make TGEU (Transgender Europe) aware of your Alliance. See http://www.tgeu.org/

The WHO's ICD-10 is in use in around 110 countries, including the UK.

ICD-10 Volume 1 The Tabular List of inclusions and four-character subcategories (Version for 2010) is available free online: http://apps.who.int/classifications/icd10/browse/2010/en

ICD-10 Volume 2 The Instruction Manual is available as a free PDF download:
http://www.who.int/classifications/icd/ICD-10_2nd_ed_volume2.pdf

ICD-10 Volume 3 The Alphabetical Index is not available online and is sold by the WHO in print and CDR format.

A separate publication for ICD-10 Chapter V Mental and behavioural disorders is also available as a free PDF download - it's known as the "Blue book":

"ICD-10 Classification of Mental and Behavioural Disorders Clinical descriptions and diagnostic guidelines": http://www.who.int/classifications/icd/en/bluebook.pdf

A number of countries have been authorized by WHO to develop "Clinical Modifications" of ICD-10: Canada, Germany and Australia all use a country specific adaptation of the international version of ICD-10.

The US lags behind the rest of the world and is still using a "Clinical Modification" of the WHO's long since retired, ICD-9.

"The National Center for Health Statistics (NCHS), the Federal agency responsible for use of the International Statistical Classification of Diseases and Related Health Problems, 10th revision (ICD-10) in the United States, has developed a clinical modification of the classification for morbidity purposes. The ICD-10 is used to code and classify mortality data from death certificates, having replaced ICD-9 for this purpose as of January 1, 1999. ICD-10-CM is planned as the replacement for ICD-9-CM, volumes 1 and 2.

"The ICD-10 is copyrighted by the World Health Organization (WHO), which owns and publishes the classification. WHO has authorized the development of an adaptation of ICD-10 for use in the United States for U.S. government purposes. As agreed, all modifications to the ICD-10 must conform to WHO conventions for the ICD. ICD-10-CM was developed following a thorough evaluation by a Technical Advisory Panel and extensive additional consultation with physician groups, clinical coders, and others to assure clinical accuracy and utility" [1].

Both the ICD-9-CM Tabular List and Index are available as free downloads from the CDC website.

In October 2013, the US will implement ICD-10-CM which has been under development for many years.

The draft of ICD-10-CM is currently subject to a partial code freeze in preparation for the changeover from ICD-9-CM to ICD-10-CM on October 1, 2013 (four months after DSM-5 is scheduled for publication, in May 2013).

The ICD-10-CM Tabular List, Index and associated documents will also be available for free download from the CDC site.

ICD-10-CM is currently available for viewing on the CDC website with the caveat:

"Although this release of ICD-10-CM is now available for public viewing, the codes in ICD-10-CM are not currently valid for any purpose or use. The effective implementation date for ICD-10-CM (and ICD-10-PCS) is October 1, 2013."

[1] ICD-10-CM release for 2012:
http://www.cdc.gov/nchs/icd/icd10cm.htm#10update

When David Elkins writes that his committee and he "are deeply concerned that the DSM-5 could be harmful to vulnerable populations such as young children, adolescents, and the elderly.." and Henry Hall follows-up with "Bad as things are for transgender, transsexual people in DSM-IV, they are expected to be even more damaging in DSM...," one is compelled to ask if DSM is a political text rather than a scientific or medical text.

If transgender and intersex people are indeed a "vulnerable population" which includes children, adolescents and the elderly, who are destined to be worse off after David Elkin's committee completes its work, then wouldn't it be more transparent to change the name of DSM-5 to "DSM Manifesto" and openly admit it is political work rather than a medical or scientific work?

It is a much more succinct title for the DSM than an equally accurate one I have been proposing for some decades. I hope you will sign the two action petitions that the PLAN T Alliance has posted...and consider joining the Alliance.