Saving Psychiatry from Itself: The DSM-5 Controversy Heats Up Again
Why an Open Letter to the DSM-5 task force is generating widespread interest
Posted October 31, 2011
Last weekend, without any fanfare or publicity, the Society for Humanistic Psychology, a division of the American Psychological Association, posted an open letter to the DSM-5 task force listing in precise, scholarly detail its many concerns about the edition's working assumptions, procedures, and recommendations. Three other APA Divisions supported the move, which also was endorsed by the Association for Women in Psychology, the Society for Descriptive Psychology, and the UK Council for Psychotherapy (UKCP).
In the space of just a week, the open letter has caught fire, earning the support of the Society for Personality Assessment, the Society for Descriptive Psychology, the Constructivist Psychology Network (CPN), and at least one previous chair of the DSM task force, Allen Frances, who endorsed the Open Letter in Psychiatric Times and on his blog for Psychology Today ("DSM-5 in Distress"). That outcome compels us to consider the irony of previous editors of the DSM urging their colleagues in Psychiatry and Psychology to reject recommendations in the forthcoming edition, arguably a consequence of senior members of the American Psychiatric Association turning their backs on their former editors, turning a deaf ear to their well-justified concerns, and casting aspersions on their motivations.
As of today, barely a week after the initiative was launched, the number of signatures has already reached the low thousands, with mental-health professionals all over the world rushing to register their concern about DSM-5. According to an email update from colleagues at the American Psychological Association, the Division that wrote the letter is also "receiving requests for interviews from professional and scientific editors."
While it's clearly too soon to say what effect the Open Letter will have on the DSM-5 task force, which in the past has stubbornly circled the wagons and blocked its ears to public and peer criticism, the initiative is already helping to build a consensus among mental-health professionals that the lowering of diagnostic thresholds, the addition of questionable disorders, and the refusal to consider environmental and other nonbiological stressors is more than a serious mistake; it is now also a grave concern. The Open Letter argues eloquently that by adding to the DSM such poorly defined and contentious illnesses as "Temper Dysregulation Dysphoria" and "Psychosis Risk Syndrome," while redefining bereavement and countenancing the future approval of "Apathy Syndrome" and "Internet Addiction Disorder," the diagnostic manual is certain to increase the number of "false positives," further distorting the prevalence rates for mental illness by overdiagnosing and overmedicating large numbers of people in the States and around the world.
In response to the massive diagnostic expansion of Post-Traumatic Stress Syndrome, Robert Spitzer (who helped approve the disorder) memorably argued that American psychiatrists subsequently needed to "save PTSD from itself." With its Open Letter to the DSM-5 Task Force, the American Psychological Association and various key organizations listed above are in effect saying, We must now try to save psychiatry from itself.
The "Open Letter to the DSM-5 Task Force" and the petition to register concern about its proposals can be read and signed here.