Leading psychiatrists question psychiatry's diagnostic manual- FINALLY!!!!!!!!

YES!!! This was my biggest complaint about trying to get help. All they did was try to fit me in that book. Then prescribed the meds that book listed for that disorder. No wonder it didn't work and I felt they didn't care. This is a good sign and hopefully things will start to change. Maybe later I will try to look for help again.




By Dr. Keith Ablow

With the new American Psychiatric Association Diagnostic and Statistical  Manual V (DSM V) slated for publication next year, leaders in American  psychiatry are criticizing the volume as unreliable. 

The DSM is the compendium of conditions psychiatrists use to diagnose their  patients and, to a great extent, determine what treatments would benefit them.   The DSM also has extremely important implications for what kinds of  psychiatric problems insurers will cover and even which ones schools and  employers will consider disabilities.

Dr. Allen Frances, professor emeritus at Duke University, who was actually  the chairman of the DSM-IV task force, asserts in a recent blog published that  the clinical trials that supposedly determined whether the new DSM V is a good  and accurate guide “have been a pure disaster from start to finish.”  He  calls the trials a “fiasco” and accuses the American Psychiatric Association of  having “lost its competence and credibility.”

Frances is by no means the only critic of the DSM-V.  I have written  before that advocates for those with autism have expressed grave concerns that  the new guidelines proposed to diagnose that condition could leave out 10 to 45  percent of those currently diagnosed with the condition, leading to millions of  children having no insurance coverage related to it.

But Frances alleges much more.  He cites data that indicates that the  DSM V signs and symptoms that are proposed to define Major Depression and  Generalized Anxiety Disorder are unacceptably inaccurate.  And he worries  that the official journal of the American Psychiatric Association, the American Journal of Psychiatry, which published a positive review of the  DSM V has been “forced into the role of a cheerleading house organ, not an  independent scientific journal.”

Given the concerns of leading psychiatrists like Frances, with whom I happen  to agree, it is time to give real consideration to fundamentally changing the  way psychiatrists use the DSM and encouraging them to think much more about what  caused the disorders they are diagnosing. 

This is the proposal of one of the most influential psychiatrists of our  time, Dr. Paul McHugh.  McHugh is Chairman Emeritus of Psychiatry at Johns  Hopkins.  He and his esteemed colleague Dr. Phillip Slavney have written in  the New England Journal of Medicine that the DSM is just a list of  conditions with signs and symptoms and offers “no way of making sense of mental  disorders.” 

Making sense of mental illnesses—describing the patient’s actual suffering  and disability—is imperative because pretending that people can be understood by  giving them a label like major depressive disorder misses the fact that many  actually complain mostly about anxiety, many others are actually grieving the  loss of a loved one, and many others have pervasive low mood, low energy and low  self-esteem that came “out of the blue.” 

McHugh and Slavney correctly wonder whether this sloppiness in simply  labeling rather than truly understanding patients explains why antidepressant  medicines—if they are being given to a very diverse group of people artificially  lumped together by the DSM—don’t seem to work much better than placebo.   Why would they, if half the people who meet the criteria for major  depression actually have other, central issues to address?

Focusing on causes would reawaken psychiatry’s commitment to looking at  people’s life stories as relevant to their suffering.  It seems strange to  say it about a profession based on insight, but too many psychiatrists  practicing today don’t know a lot about their patients’ lives; they choose  diagnoses from the DSM and pick which medicines corresponds to it.  That  isn’t treating the person.

McHugh and Slavney say it is time to enrich and augment the checklist method  of making diagnoses by starting to group mental disorders into the underlying  causes:  [roughly translated from their wording] brain diseases,  personality problems, behavioral problems and life stresses. 

The McHugh and Slavney perspective is a valuable one.  Given the rising  chorus of concern about DSM V, their thoughts, as well as those of Dr. Frances  and of autism advocates and of many others should translate into delaying  publication of the DSM-V, until it can incorporate a new respect (which is a  very old idea, indeed) for how patients got sick, to begin with, and how,  therefore, they can get well.

Read more: http://www.foxnews.com/health/2012/11/05/leading-psychiatrists-ques...

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