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Mind and Body

The new DSM-5 fails to accurately describe mental illness

With the recent release of the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5), leading experts in medicine are agreeing with what I have opined for years:  The manual fails to accurately describe and classify psychiatric illness.  I personally warned the President of the American Psychiatric Association (APA), face-to-face, that publication of the manual would be the beginning of the end of the Association’s credibility with professionals and the general public.

A few months ago, I taped a debate about the upcoming DSM with the President of the APA, slated to air on the Dr. Oz show.  After the APA President was seemingly unable to defend the Association’s positions on the manual, the show never aired.

Now, Dr. Thomas Insel, director of the National Institute of Mental Health, has stated that the book is no longer the best way to categorize psychiatric disorders for research purposes.  Translation:  The 160 or so supposedly distinct disorders don’t hold up as truly separate illnesses that can be studied scientifically.  

The British Psychological Society has opined that the 160 disorders are of “limited reliability and questionable validity.”  Translation:  The American Psychiatric Association is inventing names for conditions that don’t exist.

Dr. Paul McHugh, chairman emeritus of psychiatry at Johns Hopkins in Baltimore, Md., has written, “A recent nationwide diagnostic census based on DSM claimed that the majority of Americans have or have had a mental disorder. As a result, an appalling number of young adults in schools and colleges are on one form or another of psychiatric medication.”

Dr. Allen Frances, the esteemed psychiatrist who chaired the American Psychiatric Association’s task force that created the previous edition of the DSM, wrote this when the DSM-5 was approved for publication: “This is the saddest moment in my 45-year career of studying, practicing and teaching psychiatry. The Board of Trustees of the American Psychiatric Association has given its final approval to a deeply flawed DSM-5, containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don't follow DSM-5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication.”

With each new edition of the DSM, diagnoses are added and jettisoned, in keeping with political pressure on the committees that came up with them and the desire of the authors to make the diagnoses neatly fit in with the effects of psychiatric medications, triggering payments from medical insurance companies.  

In this latest edition of the DSM, Asperger’s disorder has been jettisoned, meaning that the millions of people diagnosed with that condition as described in DSM-IV, were apparently suffering with something else.  They will now be suffering from autism spectrum disorder, which happens to also include all the folks previously diagnosed with three other conditions, too.

Excessive eating twelve times in three months is now, according to the American Psychiatric Association, a psychiatric disorder called binge eating disorder.  That means that tens of millions of Americans are now ripe for medications targeted to save them from this supposed scourge and are nice piggy banks for counselors who will bill Blue Cross and Blue Shield to talk to them

Interestingly enough, fully 50 percent of the DSM-5 task force and working group members who helped create the binge eating diagnosis have financial ties to the pharmaceutical industry.

Being somewhat forgetful in old age is now, according to the American Psychiatric Association, a new disorder called minor neurocognitive impairment.  And if you think Medicare won’t be billed many millions of dollars so that social workers, psychologists and psychiatrists can treat forgetfulness, or that pharmaceutical companies won’t suggest that their medicines work for it (and should be covered by Obamacare), you are mistaken.

Another interesting fact: 89 percent of the DSM-5 task force and working group members who helped create this minor neurocognitive impairment diagnosis have financial ties to the pharmaceutical industry.

This should be—but probably will not be—the last Diagnostic and Statistical Manual from the American Psychiatric Association, because the APA has lost its credibility as an organization able to accurately describe what patients suffer from and how psychiatrists actually heal people.  It was under APA’s leadership and the commands of third-party insurers that the professional lives of thousands of psychiatrists were reduced to writing prescriptions for six patients every hour rather than talking to patients about their life stories.  

For those of us who always knew that psychiatric disorders are complex interplays of emotion and behavior and neurochemistry, who always knew that human beings need to be understood as individuals, who always knew that major depression is often heralded by terrible anxiety and that terrible anxiety is depressing, who always knew that many people with attention deficit disorder had plenty going on in their lives that no one would want to pay attention to, the DSM was always understood as a self-published, self-serving document that fell far short of reality and had limited value.  Now, with the DSM-5’s release, the word is truly out:  We in psychiatry need an honest, accurate diagnostic manual – and we don’t have one.

Psychiatry also needs an honest professional guild, something we also don’t have.  There is a ray of hope, however.  There always is.  This time, it is the selection of Dr. Paul Summergrad, as president-elect of the APA, the chairman of the department of psychiatry in which I teach, and one of the wisest psychiatrists I have been privileged to know.

Dr. Keith Ablow is a psychiatrist and member of the Fox News Medical A-Team. Dr. Ablow can be reached at info@keithablow.com.