Monday, June 01, 2009

Shroud of Secrecy of the DSM-V

I saw this article linked by Ann Althouse (guestblogging at Instapundit) on the new DSM-V which, apparently has a number of new diagnoses added to it. For those of you not familiar with the DSM, it is the mental health bible used to make diagnoses of mental disorders. The new diagnoses being considered for inclusion in the DSM-V range from sex addiction to internet addiction. There are a number of critics of the way that mental health professionals diagnose these disorders:

Even though the APA asked the psychiatrists working on the manual’s revision to sign a nondisclosure agreement, leaked proposed additions to the new version have already stirred debate. “Psychiatrists manufacture mental diagnoses the way the Vatican manufactures saints,” says Dr. Thomas Szasz, an outspoken critic of modern psychiatry and author of Psychiatry: The Science of Lies. This view may be extreme, but some of the new “mental illnesses” under consideration for the new edition nonetheless sound a little…crazy. Here are eight you may already be suffering from, whether you knew it or not.


While I think that many of the diagnoses in the DSM are useful at helping mental health professionals agree on what a cluster of behavioral symptoms mean and what they should be called, I also agree that much of "normal behavior" is pathologized. But my main concern is the secrecy of the DSM-V--only a group of psychiatrists and one psychologist are allowed to oversee the revision and they have been asked to sign confidentiality agreements. Psychologists are up in arms about being excluded from the process but a more pressing concern is that a small group of psychiatrists is making decisions about what is normal vs. abnormal behavior.

Shouldn't there be more oversight than this? Why the need to be so secret about what is being put in this manual? Why not have a more diverse group of mental health experts and others involved? I remember when we talked with APA past president Nicholas Cummings about how diagnoses were chosen for the DSM--apparently some are just reached by consensus. Huh, no research, just a decision based on a group of potentially PC or biased individuals without the research to back it up? What kind of science is that? I am started to think Szasz has a point.

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44 Comments:

Blogger JG said...

Maybe they're going to reinstate homosexuality as a mental illness.

You can't take a bunch of self-important people who strictly make definitions according to the current PC climate TOO seriously.

2:29 PM, June 01, 2009  
Blogger JG said...

I've been lobbying for years to have that mental illness included where you get seizures when you hear Mary Hartman's voice on TV.

Do they listen to me? Huh.

2:30 PM, June 01, 2009  
Blogger JG said...

Or maybe it's already included - I haven't thumbed through the DSM-IV manual lately (or ... in fact ... ever).

2:31 PM, June 01, 2009  
Blogger Dave Cornutt said...

Helen, as I was reading through your post, my first thought was, "That process is about the exact opposite of peer review". So I'm right there with you on that last paragraph. I'd hate to see psychology and psychiatry go in the direction of some other formerly respectable health fields (exhibit A: nutrition) which have degraded themselves to the status of pseudo-science.

3:22 PM, June 01, 2009  
Blogger TMink said...

"What kind of science is that?"

No science at all. Science does not enter into it. Even when the diagnoses were scientifically driven, say as with ADHD, the editors of the DSM-IV cut off a research based criteria because they did not like the number of criteria given. There was no dealing with the brain scans or data, the editor just wanted a different number.

The problem is that insurance companies and the government and other people will use the newest DSM and in that way it affects our lives.

No psychologists on the panel is a problem as it is usually the psychologists who are more behaviorally research based while the psychiatrists are typically versed in medications.

I think this may not be pretty.

Trey

3:58 PM, June 01, 2009  
Blogger JG said...

I think one of the problems with the so-called "soft sciences/disciplines/subjects" (aside from the fact that they are getting really politically correct) is that they are trying too hard to be like the hard sciences. They are trying to put things on a mathematical basis (or at least appear that way) when that type of approach is not warranted. They should stick to the level of precision that is warranted: not much.

Paradoxically, though, one of the few areas of psychology that I have any respect for involves these tests where random questions (like: Do you like raw carrots or cooked carrots?) are asked, and then the answers are compared to the answers of people with specific mental illnesses or specific traits (for instance sales ability). For some reason, they tend to answer the questions similarly, although there may not be an obvious reason. These tests can also be predictive.

I think they WORK to a certain extent. Lots of other stuff in psychology (for instance Rorschach tests) is utter nonsense and no better than tea-leave reading. And I've seen some objective studies on Rorschach tests.

4:11 PM, June 01, 2009  
Blogger njartist said...

I see that pulling a Dagwood - night eating - is now considered a disorder. The binge eating can also be called a Dagwood: remember the huge sandwiches?

Do they have a companion Television Addiction to go with the Internet Addiction?

5:22 PM, June 01, 2009  
Blogger Vicki said...

That's why I don't understand why so much weight is given to the DSM IV by experts. Its a reference tool that needs to be under constant review by an ever-changing Board selected nation wide.

So why any 'closed' method? Visions of grandeur, power, control, greed (?). Uh oh, I smell narcisissm - a diagnosis!

5:30 PM, June 01, 2009  
Blogger JG said...

"Visions of grandeur, power, control, greed (?)."

-----

Yup.

And a touch of overrating their own self-importance.

No offense to the psychologists here - not all are like that - but for some reason that is a field in which people vastly over-rate themselves. No idea why.

5:33 PM, June 01, 2009  
Blogger Peregrine John said...

Ah, Vicki got to it before I did! To wit:

Curious that the problems with the new edition's process can be pretty easily described by things one might expect to find within it.

5:37 PM, June 01, 2009  
Blogger Rob Fedders said...

I heard the Marxist code word "consensus" being spoken on the web, and so I ran over here as fast as I could!

Don't forget, the goal of Hopenchange & Shitlery (Marxists) is Humanism (Marxism). This is of course, the belief that Man is God himself, and man can rule the world by science.

Of course, they don't mean science like mathematics - because that is based in absolutes that they can't manipulate. They mean the SOCIAL SCIENCES, because they are malleable and are grrrrrreat for being able to manipulate society in which ever direction the overlords wish.

I do believe that in Communist countries it was not so much "illegal" to be a Christian, as it was the social scientists said that anyone who believed in God was mentally ill, and so "they took you away." (The real reason was that the Bible's absolutism is contradictory to Marxism's relativism - the two cannot co-exist).

I think I read a while back that some social scientists affiliated with the APA also started saying that religious people were suffering from some sort of mental illness or delusions or something like.

But there we are, what do I know, eh? I am just a poor lonesome country boy with nothing but chicken wire to sit on and a rusty marble to play with.

Social Science was created to destroy human freedom The French philosopher/mathematician, Auguste Comte (1798-1857) devoted his entire intellectual life to perfecting plans for a WORld Management System (WORMS) , He believed human activities should be controlled by an intellectual elite whom he called 'social scientists.'

5:47 PM, June 01, 2009  
Blogger JG said...

"I think I read a while back that some social scientists affiliated with the APA also started saying that religious people were suffering from some sort of mental illness or delusions or something like."

----------

Yeah, I can see that one coming.

I'm personally kind of agnostic - meaning I have no idea what the ultimate reality is - and I also have a big ego - but even I see the need to leave it be when it comes to religious beliefs. It's not that I *pretend* to be tolerant, it's that I have no idea what the truth is - and the Christian people may well be right. Or the Buddhist people.

But when people develop such an expansive ego that they think they know the ultimate truth about the universe - and they are going to call anyone with divergent viewpoints "mentally ill" - I think they themselves may have cross the line, at least to megalomania.

5:54 PM, June 01, 2009  
Blogger JG said...

Errata:

"cross the line" = "crossed the line"

"- and I also have a big ego -" = "- others have mistakenly asserted that I have a big ego -"

5:58 PM, June 01, 2009  
Blogger J. Bowen said...

So, if they get their way and declare internet addiction a disease, can I get disability checks from the government if I can prove that the addiction that I claim to have interferes with my life?

6:09 PM, June 01, 2009  
Blogger br549 said...

Wasn't there some buzz around about 3 or 4 years ago about conservative / republican types having issues with change - and that, perhaps, was a disorder of some type?

Hell, let's all go to Manhattan, have dinner, and take in a play - while Rome burns.

6:35 PM, June 01, 2009  
Blogger randian said...

Raping the public school system to get Americans with Disability Act dollars for your kid is a popular pastime these days, and a new DSM will likely greatly expand the ways both government and private employers can be abused under the auspices of the ADA.

7:07 PM, June 01, 2009  
Blogger TMink said...

"Raping the public school system to get Americans with Disability Act dollars for your kid is a popular pastime these days"

Completely true. I had a mom who brought her slightly inattentive child to me trying to get him on disability. I talked to her about how that would put him in inferior classes and lable him for life, but she would have none of it.

Finally I told her that I would not get somone with less ADD than I have on disability.

She fired me.

Trey

8:19 PM, June 01, 2009  
Blogger William said...

But there is no science in psychology or psychiatry. Any disease with a medical or scientific base turns into the purview of the neurologists.

The rest is just making it up as you go along.

11:30 PM, June 01, 2009  
Blogger TMink said...

William, I recommend to you the work of Daniel Amen, a psychiatrist with years of brain research. A simple web search will yield more hard science research than you can read in a year.

Also, Scott Miller and his crew have done tons of number crunching to consider what works in psychotherapy. It is evidence based and not the proper consideration of neurologists as it examines human interactions that facilitate behavioral change rather than brain functioning. Not that brain functioning is not a fascinating subject.

Trey

8:21 AM, June 02, 2009  
Blogger I R A Darth Aggie said...

They're going to classify conservatism as a mental illness.

Trust me, it's coming.

9:49 AM, June 02, 2009  
Blogger TMink said...

IRA, Michael Savage classifies liberalism as a mental disorder. I think he wrote a book with that title. I listen to him on the way back from a group I run (on Tuesday nights so tonight as a matter of fact) and agree with him occasionally.

You can make a good case for the extreme leftists having a damaged prefrontal orbital cortex. This is the part of the brain that makes us seek relationships and that allows us to remain calm when someone says or does something that we do not like.

To see what a person with a non-functioning POFC acts like, just read some of the over the top comments on the blogs! There may even be some coming now. 8)

Trey

10:57 AM, June 02, 2009  
Blogger DADvocate said...

Thomas Szasz it right. I read his "Myth of Mental Illness" years ago. The last time I looked at the DSM it was version III. Virtually anyone could be labeled as having a mental illness at that point.

I think the threats of religion, conservatism and other non-PC beliefs being labeled mental illnesses are real.

Having a father who was a clinical psychologist and having about ten years of experience in mental health/social services myself, I can attest to the fact that psychiatrists, psychologists, social workers, etc have no lock on normalcy. (Present company excluded of course.) I also found a great deal of narcissism amongst those people. They have knowledge and insight beyond the grasp of ordinary people.

11:02 AM, June 02, 2009  
Blogger Rob Fedders said...

One waits in vain for psychologists to state the limits of their knowledge. -- Noam Chomsky

As someone who has a sibling with a Ph D in Psychology, (and who has met several of her friends & colleagues), and who is also no fan of Chomsky... I must admit that Chomsky proves once again that even a stopped clock is right twice a day.

It's amazing, isn't it? However did humans survive before the arrival of the social sciences? Phew! It must have been pure luck.

The spanking children thing really puzzles me. I mean, of course Abraham Lincoln & George Washington got severely screwed in the head because they were spanked as children... but, I guess that's because children were different back then. I know they were born with tails, and I think I heard somewhere that they even used to have green skin.

Well, I can't hang around for too long. I've got to get back to work on my Alchemy dissertation.

11:56 AM, June 02, 2009  
Blogger TMink said...

"The spanking children thing really puzzles me."

Me too! A lot of parents expect me to be anti-spanking and I am not at all. I am anti-abuse, but that is another matter entirely.

I think much of the psych crowd subscribes to the school of thought that people are basically good and their environment turns them bad. As a Christian, I hold that people are born basically selfish and amoral and good parenting socializes us and turns us into passable citizens. So while the majority of ologists and iatrists believe we are all basically OK, I know too many people and myself well enough to disagree with that position.

Trey

12:06 PM, June 02, 2009  
Blogger William said...

Trey

My undergraduate degree was in neuropsych. My residency was in Psychiatry. I've been in practice for ten years.

My statement stands.

12:11 PM, June 02, 2009  
Blogger David said...

"Psychiatrists manufacture mental diagnoses the way the Vatican manufactures saints"

Does someone play the role of Devil's Advocate?

12:43 PM, June 02, 2009  
Blogger Wayne said...

A lot of parents expect me to be anti-spanking and I am not at all. I am anti-abuse, but that is another matter entirely.

I was thinking about the difference today, and if you notice, the terms that the Left use are biased (shocker). They never make a distinction between spanking and abuse. They always use the term, "hitting", because "hitting" implies the more abusive act in the mind of the person hearing it.

12:46 PM, June 02, 2009  
Blogger J. Bowen said...

I was at the Shedd Aquarium in Chicago with some friends. The grandmother of the little kids of the friend through whom I knew all of the rest of them spanked one of the kids for throwing a tantrum in the middle of the cafeteria. You should have seen the rest of the people in the cafeteria. The looks on their faces were priceless.

1:11 PM, June 02, 2009  
Blogger Chuck Pelto said...

TO: Dr. Helen, et al.
RE: The New-Improved DSM

I look forward to the interpretation and use of item #8 as listed at....

http://www.thedailybeast.com/blogs-and-stories/2009-05-28/8-new-ways-you-might-be-insane/?cid=hp:originalslist4

This one little beauty is called "Pathological Bias". And, if looked at in an objective manner, ANYONE who is 'out of favor' with the 'establishment', can be 'diagnosed' as such. This is the sort of tool used by our friends the Sovs to put people who mental institutions, i.e., an upscale 'gulag'.

All the pieces are falling into their 'proper' place.

Regards,

Chuck(le)
[A free society is one where it is safe to be 'unpopular'.]

1:20 PM, June 02, 2009  
Blogger TMink said...

William wrote: "My statement stands."

As does my assessment of your opinion on this matter. 8)

Trey

3:17 PM, June 02, 2009  
Blogger MB said...

TMink has spoken his assessment.

Pure arrogance combined with pure denseness. A perfect 10, and very representative of his profession.

{light golf claps} good show

6:12 PM, June 02, 2009  
Blogger MB said...

Although William is pulling a bit of a dramatic moment, I basically agree with him.

6:13 PM, June 02, 2009  
Blogger workinwifdakids said...

Here's a fan favorite: me and my buddy (we're both teachers) go to the School Psychologist's office and pull out the DSM-IV. With great flourish and fanfare I open the book to any random page and start reading symptoms.

This week, I "diagnosed" him with cocaine withdrawals. Awesome! It's a game the whole family can play!

8:01 PM, June 02, 2009  
Blogger TMink said...

workin, there is no need to limit your fun to the American and European traditions. Diagnose your buddy with koro.

Trey

12:17 AM, June 03, 2009  
Blogger JG said...

Workinwifdakids sez: "This week, I "diagnosed" him with cocaine withdrawals."

---------

For some reason, the scene in the movie "Airplane" came to mind where the doctor was describing the symptoms of fish poisoning and the pilot was getting them one-by-one.

But yeah, I think that in addition to the DSM manual, diagnosis requires a stroking of the chin (preferably with a goatee) on the part of the psychologist and deep, deep thought that ordinary men are not capable of.

3:23 AM, June 03, 2009  
Blogger JG said...

As part of a job interview with a kind-of-strange company once, I had to talk to the company psychologist.

I went in the little room and a woman was sitting behind the desk in a kind of pompous way. She made "small talk" with me for a while, and then suddenly leaned back in her chair, started tapping the tips of her fingers together in a kind of steeple fashion and then said: "Let's take a break and just play a game. Just for fun". I was to then say the first thing that popped into my mind when she said cue words like "Boss" or "Work".

Since it was a job interview, the answers were, of course, quickly "filtered" in my mind so that an appropriate and reasonable answer was given.

The woman was as arrogant and condescending as they come. What an idiot.

3:28 AM, June 03, 2009  
Blogger JG said...

The result was: Job offer but I didn't take it. So I guess my answers met with her approval (or maybe the company didn't put much stock in her evaluations).

3:43 AM, June 03, 2009  
Blogger JG said...

I've heard of "stress interviews" where they try to rile you up to see how you react, and maybe that was some kind of test as to how I respond to condescending buffoons (although it was an engineering job, not a sales job). You never know.

3:55 AM, June 03, 2009  
Blogger TMink said...

"Let's take a break and just play a game. Just for fun"

So she was also a liar.

Trey

8:12 AM, June 03, 2009  
Blogger Chuck Pelto said...

TO: JG
RE: Psychic Interviews

"Let's take a break and just play a game. Just for fun". I was to then say the first thing that popped into my mind when she said cue words like "Boss" or "Work". -- JG

I could have all kinds of fun with that one.

Course of Action #1:

"Oh. Goody! I like playing games."

And then go into the mode of Charles Bronson during his psych interview in The Dirty Dozen.


Course of Action #2:

"No. That's a dull sort of game. How about a nice game of chess?"


Course of Action #3:

"And whose going to have the 'fun' here? Play with yourself, woman." Get up and walk out.


If things at that company work like that do in Office Space, they'd probably have offered me a position as a VP of Marketing.

Regards,

Chuck(le)

9:32 AM, June 03, 2009  
Blogger Chuck Pelto said...

TO: JG
RE: Perhaps....

....maybe that was some kind of test as to how I respond to condescending buffoons.... -- JG

....it was a necessary 'stress test' because upper management IS a BUNCH of "condescending buffoons".

Regards,

Chuck(le)

9:38 AM, June 03, 2009  
Blogger br549 said...

I spanked my kids when necessary when they were young. One time, straight on the fanny, then off to their room. The single swat never had power behind it. It was the definitive "you have crossed the line" statement, and it was always followed by "off to your room" - where their stereo was, TV, telephone...........(sigh).

7:11 PM, June 03, 2009  
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12:44 PM, June 10, 2009  
Blogger Chuck Pelto said...

TO: br549
RE: Me Too

I spanked my kids when necessary when they were young. One time, straight on the fanny, then off to their room. -- br549

Me too.

The one good swat was to get their attention. Any more was self-gratification....or worse.

Then, instead of into their room—where I could not 'supervise' them—it was into a corner.

Afterwards, I'd take them out of there, hold them on my lap and explain how serious the situation was for them to be doing 'that'.

Regards,

Chuck(le)
[You know you were a good parent, if your grand-children turn out right.]

8:30 PM, June 10, 2009  

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