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REAL WORLD EVENT DISCUSSIONS
New debate about mental illness and the upcoming DSM-5
Tuesday, February 1, 2011 8:55 AM
NIKI2
Gettin' old, but still a hippie at heart...
Quote:Allen Frances, lead editor of the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (universally known as the DSM-IV), the guy who wrote the book on mental illness, confessing that “these concepts are virtually impossible to define precisely with bright lines at the boundaries. There is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.”
Quote:Every fight over nomenclature threatens to undermine the legitimacy of the profession by revealing its dirty secret: that for all their confident pronouncements, psychiatrists can’t rigorously differentiate illness from everyday suffering. This is why, as one psychiatrist wrote after the APA voted homosexuality out of the DSM, “there is a terrible sense of shame among psychiatrists, always wanting to show that our diagnoses are as good as the scientific ones used in real medicine.”
Quote:Frances explains why he came out of a seemingly contented retirement to launch a bitter and protracted battle with the people, some of them friends, who are creating the next edition of the DSM. And to criticize them not just once, and not in professional mumbo jumbo that would keep the fight inside the professional family, but repeatedly and in plain English, in newspapers and magazines and blogs. And to accuse his colleagues not just of bad science but of bad faith, hubris, and blindness, of making diseases out of everyday suffering and, as a result, padding the bottom lines of drug companies. These aren’t new accusations to level at psychiatry, but Frances used to be their target, not their source. He’s hurling grenades into the bunker where he spent his entire career.
Quote:In its first official response to Frances, the APA "diagnosed" him with “pride of authorship” and pointed out that his royalty payments would end once the new edition was published—a fact that “should be considered when evaluating his critique and its timing.” Frances, who claims he doesn’t care about the royalties (which amount, he says, to just 10 grand a year), also claims not to mind if the APA cites his faults. He just wishes they’d go after the right ones—-the serious errors in the DSM-IV. “We made mistakes that had terrible consequences,” he says. Diagnoses of autism, attention-deficit hyperactivity disorder, and bipolar disorder skyrocketed, and Frances thinks his manual inadvertently facilitated these epidemics—-and, in the bargain, fostered an increasing tendency to chalk up life’s difficulties to mental illness and then treat them with psychiatric drugs. The insurgency against the DSM-5 has now spread far beyond just Allen Frances. Psychiatrists at the top of their specialties, clinicians at prominent hospitals, and even some contributors to the new edition have expressed deep reservations about it. Dissidents complain that the revision process is in disarray and that the preliminary results, made public for the first time in February 2010, are filled with potential clinical and public relations nightmares. Although most of the dissenters are squeamish about making their concerns public-—especially because of a surprisingly restrictive nondisclosure agreement that all insiders were required to sign—-they are becoming increasingly restive, and some are beginning to agree with Frances that public pressure may be the only way to derail a train that he fears will “take psychiatry off a cliff.” The book is the basis of psychiatrists’ authority to pronounce upon our mental health, to command health care dollars from insurance companies for treatment and from government agencies for research. It is as important to psychiatrists as the Constitution is to the US government or the Bible is to Christians. Outside the profession, too, the DSM rules, serving as the authoritative text for psychologists, social workers, and other mental health workers; it is invoked by lawyers in arguing over the culpability of criminal defendants and by parents seeking school services for their children. If, as Frances warns, the new volume is an “absolute disaster,” it could cause a seismic shift in the way mental health care is practiced in this country. It could cause the APA to lose its franchise on our psychic suffering, the naming rights to our pain.
Quote: Since 1980, when the DSM-III was published, psychiatrists have tried to solve this problem by using what is called descriptive diagnosis: a checklist approach, whereby illnesses are defined wholly by the symptoms patients present. The main virtue of descriptive psychiatry is that it doesn’t rely on unprovable notions about the nature and causes of mental illness, as the Freudian theories behind all those “neuroses” had done. Two doctors who observe a patient carefully and consult the DSM’s criteria lists usually won’t disagree on the diagnosis-—something that was embarrassingly common before 1980. But descriptive psychiatry also has a major problem: Its diagnoses are nothing more than groupings of symptoms. If, during a two-week period, you have five of the nine symptoms of depression listed in the DSM, then you have “major depression,” no matter your circumstances or your own perception of your troubles.
Quote:The DSM-5 battle comes at a time when psychiatry’s authority seems more tenuous than ever. In terms of both research dollars and public attention, molecular biology—-neuroscience and genetics-—has come to dominate inquiries into what makes us tick. And indeed, a few tantalizing results from these disciplines have cast serious doubt on long-held psychiatric ideas. Take schizophrenia and bipolar disorder: For more than a century, those two illnesses have occupied separate branches of the psychiatric taxonomy. But research suggests that the same genetic factors predispose people to both illnesses, a discovery that casts doubt on whether this fundamental division exists in nature or only in the minds of psychiatrists. Other results suggest new diagnostic criteria for diseases: Depressed patients, for example, tend to have cell loss in the hippocampal regions, areas normally rich in serotonin. Certain mental illnesses are alleviated by brain therapies, such as transcranial magnetic stimulation, even as the reasons why are not entirely understood. In recent years, the National Institute of Mental Health has launched an effort to transform psychiatry into what its director, Thomas Insel, calls clinical neuroscience. This project will focus on observable ways that brain circuitry affects the functional aspects of mental illness—symptoms, such as anger or anxiety or disordered thinking, that figure in our current diagnoses. Although the APA doesn’t disagree that a revolution might be on the horizon, the organization doesn’t feel it can wait until 2020, or beyond, to revise the DSM-IV. Its categories line up poorly with the ways people actually suffer, leading to high rates of patients with multiple diagnoses. Neither does the manual help therapists draw on a body of knowledge, developed largely since DSM-IV, about how to match treatments to patients based on the specific features of their disorder. The profession cannot afford to wait for the science to catch up to its needs. Which means that the stakes are higher, the current crisis deeper, and the potential damage to psychiatry greater than ever before. Allen Frances’ revolt against the DSM-5 was spurred by another unlikely revolutionary: Robert Spitzer, lead editor of the DSM-III and a man believed by many to have saved the profession by spearheading the shift to descriptive psychiatry. As the DSM-5 task force began its work, Spitzer was “dumbfounded” when Darrel Regier, the APA’s director of research and vice chair of the task force, refused his request to see the minutes of its meetings. Soon thereafter, he was appalled, he says, to discover that the APA had required psychiatrists involved with the revision to sign a paper promising they would never talk about what they were doing, except when necessary for their jobs. “The intent seemed to be not to let anyone know what the hell was going on,” Spitzer says. Frances found out about a new illness proposed for the DSM-5. In May 2009, during a party at the APA’s annual convention in San Francisco, he struck up a conversation with Will Carpenter, a psychiatrist at the University of Maryland. Carpenter is chair of the Psychotic Disorders work group, one of 13 DSM-5 panels that have been holding meetings since 2008 to consider revisions. At the party, Frances and Carpenter began to talk about “psychosis risk syndrome,” a diagnosis that Carpenter’s group was considering for the new edition. It would apply mostly to adolescents who occasionally have jumbled thoughts, hear voices, or experience delusions. Since these kids never fully lose contact with reality, they don’t qualify for any of the existing psychotic disorders. Frances found psychosis risk syndrome particularly troubling in light of research suggesting that only about a quarter of its sufferers would go on to develop full-blown psychoses. He worried that those numbers would not stop drug companies from seizing on the new diagnosis and sparking a new treatment fad-—a danger that Frances thought Carpenter was grievously underestimating. He already regretted having remained silent when, in the 1980s, he watched the pharmaceutical industry insinuate itself into the APA’s training programs. (Annual drug company contributions to those programs reached as much as $3 million before the organization decided, in 2008, to phase out industry-supported education.) Frances didn’t want to be “a crusader for the world,” he says. But the idea of more “kids getting unneeded antipsychotics that would make them gain 12 pounds in 12 weeks hit me in the gut. It was uniquely my job and my duty to protect them. If not me to correct it, who? I was stuck without an excuse to convince myself.” Frances warned that the new DSM, with its emphasis on early intervention, would cause a “wholesale imperial medicalization of normality” and “a bonanza for the pharmaceutical industry,” for which patients would pay the “high price [of] adverse effects, dollars, and stigma.”
Tuesday, February 1, 2011 9:14 AM
BYTEMITE
Tuesday, February 1, 2011 9:28 AM
Tuesday, February 1, 2011 11:07 AM
PHOENIXROSE
You think you know--what's to come, what you are. You haven't even begun.
Tuesday, February 1, 2011 11:15 AM
Tuesday, February 1, 2011 12:16 PM
THEHAPPYTRADER
Tuesday, February 1, 2011 1:19 PM
FREMDFIRMA
Tuesday, February 1, 2011 3:09 PM
Tuesday, February 1, 2011 4:26 PM
CANTTAKESKY
Quote:Originally posted by Fremdfirma: Also, the DSM IV is prettymuch a handful of excuses to avoid saying "we don't know", and the DSM V is just a shill for Big Pharma, I think we all know this, but don't really wanna admit it.
Tuesday, February 1, 2011 9:34 PM
RIONAEIRE
Beir bua agus beannacht
Tuesday, February 1, 2011 11:45 PM
MAGONSDAUGHTER
Wednesday, February 2, 2011 3:55 AM
Wednesday, February 2, 2011 4:31 AM
Wednesday, February 2, 2011 7:33 AM
Wednesday, February 2, 2011 3:47 PM
Wednesday, February 2, 2011 4:31 PM
Wednesday, February 2, 2011 4:51 PM
Wednesday, February 2, 2011 7:03 PM
Wednesday, February 2, 2011 7:10 PM
Thursday, February 3, 2011 1:11 PM
Thursday, February 3, 2011 1:21 PM
Thursday, February 3, 2011 1:26 PM
WULFENSTAR
http://youtu.be/VUnGTXRxGHg
Thursday, February 3, 2011 1:36 PM
Quote:Cus going out and actually making something of yourself is too damn hard.
Thursday, February 3, 2011 1:41 PM
Friday, February 4, 2011 6:59 AM
Friday, February 4, 2011 7:04 AM
Quote:Anyhows, you wanna talk about tough women, listen to some of the RAWA girls at them orphanages, it wasn't like they be-bopped down to the local womens shelter, and that's some seriously badass desert out there, makes my rescue run through tecate look like a walk in the park, and it ain't like they just let em go neither, more than one slit throat among them stories, lemme tellya. But there's many types of courage - it's one thing to be fearless when you're quick, tough, and skilled enough to apparently *still* be quite threatening from a damn wheelchair... (And that WAS funny - "He wheeled towards me in a threatening manner!") And yet there's also the courage to stay your hand when every ounce of you cries out to strike, and sometimes that's the hardest courage of all. Watch Pans Labyrinth - Mercedes tremendous courage struck even my black heart, I could not have done that, and when she *did* strike damn she made it count. But it's a whole nother ballgame entire when you're weak, helpless, unskilled, even ignorant of your options, or even that you have any. And so, lemme explain about Wendy, a former DeVee who's insinuated herself somewhere between would-be paramour and self-adopted bratty daughter and shows no intent to budge. Given what we know of early development, she had to have known love, once, probably before the development of linear coherent memory, but as a product of the Foster Care System she certainly has no memory of any - by all rights she should be a wolf-child, the usual result of what I call Closet Kid Syndrome, and damn us all that I even need a term for something so awful it shouldn't even exist. All she knew for so very long was darkness, silence, hunger, it was ALL she knew, you understand - hell even a beating shows someone cares, cares enough to hate, but there's times that ain't nothing worse.. than nothing. Who knows what started it, a memory, a sound, probably a scent of spring, since the girl has an amazing sense of smell, but at some point she up and decided she was gonna pick her time and go for it - completely unknowing of the fact that we had recently been called in by a concerned relative who was fearful that the girl was prolly buried in the back yard, who came to us after two years of trying to get someone, anyone, to investigate... That's not a bash on the system, though I've got the right - so much as they didn't go about it well, had nothing to offer in the way of reason or evidence, and were very tenative for fear of bringing that system down upon their own heads, and finally in desperation went to the darker side and thankfully drew our attention before getting in over their heads with something unpleasant. Now, I don't believe what other folks believe, but the situation as it unfolded simply defies any logical, rational explaination, longshots like that only happen in bad hollywood B-flicks, and it kinda offends my sense of a sensible reality to have that dropped on my head like an Acme Anvil from a merry melodies cartoon, mind you, call it fate, destiny, whatever, for the kid to pick THAT moment, to make her break, defies all sensibility, especially since she's never been able to explain or articulate why herself. Hell, maybe it's a bright version of the dark wind that seemed to follow Jelly Brice, causing hardcore mobsters to instantly surrender when he showed up despite having no manner of knowing it... sorry, digressing... Anyhows, so this tiny, quiet, badly malnourished and neglected girl picked her time and glory-rushed the door for all she was worth, and it was worth a LOT since she had just recently tipped into the age bracket where the berserkerang usually first manifests itself - I swear, the place looked like a bomb hit when they came to take evidence pictures, she went full bore zerk on the whole bloody place since she couldn't see to hit anything in particular. Yeah, she has permanent vision damage, mind you, another aspect of Closet Kid Syndrome, but there's a real whiz optometrist here and we've been working with various lenses and filters, she's been real patient since this might help others down the road, though obviously it'd be better if there WEREN'T any others, but still, she can see ok only after sunset, and will never be able to drive a car, but she can SEE - which at that time, she could not, it was all one big, bright, loud blur to her, you see. But using memory of footstep sounds from above, remembered layout, scent, hell, for all I know it was the friggin force, she made it to, and through, the front door, leaving it hanging on one badly bent top hinge, and hightailed it as fast as possible, somewhere, anywhere, just, AWAY - not even thinking to howl at the top of her lungs cause it never occured to her, all she knew, all she hoped, was that people weren't evil and SOMEONE would be there to rescue her if she could only get loose long enough for it to happen, the sheer STRENGTH of that belief, that courage, that she put her entire extistence on the line, so far as she knew, betting everything she had, little that it was, on simple human decency, despite never having known it in her own memory - what do you SAY to that ? Even more bizarre, what do you say to that absolute surety, that certainty, when you happen to be the one who WAS there, and it makes utterly no sense to YOU ? And so there's me, with nothin but a vague description to work with, doing a slow cruise-by and mentally marking out spots to place a couple observers to see who comes and goes, too cursed early and not completely mentally "with it" all that well quite yet - and WHAM, out that door comes this teensy girl who matches the vague description and has no other reason to be there, with one of the Fosters in hot, injured, angry pursuit... One of my edges is being so quick on the uptake some folk take it for prescience, and before my brain caught up enough to sputter WTF? my reflexes were already in gear and active, snapped the wheel hard and heel stomped the brakes to swing the back end loose and cut the angle, reaching out and flicking the door latch as I locked the brakes up again to stop and fling the door wide - and yelled TAKE MY HAND! - she flailed for it, caught a grip like a set of visegrips and I hauled her into the car and took off so fast apparently they never even got a plate number, not that it woulda mattered so much later, but it did forestall any immediate problems that I was long and away GONE before the Fosters even thought to notify anyone - them bein reluctant for some damned obvious reasons. I hadn't connected it cause imma dolt sometimes, and for me a certain degree of kindness is so automatic I don't even notice - but en route to a safe place, I thought to give her some food since she was so obviously malnourished, and woulda gone with somethin like a small set of chicken nuggets or something equally tiny and bland (I have far more experience than I ever wanted in dealing with really damaged people) but that she couldn't see complicated that, so I bought her a strawberry milkshake. The girl has a thing for strawberries now that borders on a junkies need for a fix, cause apparently it's wired in as what freedom tastes like. So we wound up getting her emancipated, via some rather unpleasant legal wrangling that left me with a bad taste in my mouth cause it didn't blacklist those evil gits from the list of potential Fosters, but at least it cut her loose of them, and she went through the usual recovery process as well as some stuff tailored to her specific problems - and incidentaly kinda speeded my retirement cause when I gave her the final exam for personal self defense she handed me my ass so bad she thought she'd killed me and started freakin out about it - I *did* mention she can zerk, right ? And she's younger, faster and more agile - after ascertaining that I was ok and only mostly stunned and roughed up, that bastard Justin was laughing so hard he was in tears... prick. Well, due to my physical condition and the recent ass-handing there, I was kinda desperate for someone to help cover site three, and after another girl didn't work out cause she was totally unsuited to the work, I asked Wendy if she would be willing to assist me even if it meant facing her greatest fears a little earlier than expected, and she said ok. Not sure if I went into detail about this bit or not, but the ones who are not "ok" yet, they wear cat ears as a visible tell of this so that everyone we deal with knows to treat them with kid gloves, especially as part of the therapy needfully involves teaching them self-defense before they're safe to be around most folk cause it's an integral part of the recovery - the ears coming off is like a seriously big deal and usually at the end of a graduated reintro to "normal" society with little party and everything, see... And that decision usually falls to the folk most involved in their recovery process - it's part of an old joke that caught on as a way to set a visible flag without makin em feel like lepers, is all. So, I start training her to do security rounds, which she has natural talent for, and since she can walk to work, and can actually see, is something she can DO instead of feeling helpless - but there it is, the quiet, silent darkness she fears the worst, you see ? And she was a bit skittish at first, but thing was, in that environment, it's HER world, where others are blind, she can see, where others are weak, she is strong, other people will look up to HER for protection and assistance in the cold, quiet darkness... And she stops - I worry that she might be losing it, but she just has this perplexed look on her face, and finally she says in this itty bitty stunned voice.. "I don't have to be afraid anymore.", and then, again, bold and confident... And she reaches up, pulls those ears off and hands em to me. "And I will NEVER be afraid again." I can be brave, I can be fearless, but I know it's a sham when more than half that courage is cause I happen to be slightly mad by any definition, and most of it has been mostly cause at the time I had nothin to lose, but yeah, I got some sand down there at the bottom of it all. But I ain't even in the same class as that girl, not by a longshot - she took her own nightmare and conquered it, made herself it's ruler, instead of it's victim, and she took that last step, as she took the first one, of her own will and unassisted. Kid's got more guts in her pinky than I got in my whole being, seriously. I've heard and seen worse, but I figured I would relate hers cause she gave me permission and it has a happy ending and all - you cannot imagine how it made me feel to watch her take that final step, to watch it happen right in front of me. Machismo means jack shit to someone who's seen real courage, often enough when folks paid for it with their life or worse, and frankly, for straight flat out and out courage in all of the more important non-physical ways ? I'm betting on XX over XY - based on how many of each actually pull through.
Friday, February 4, 2011 10:26 AM
KANEMAN
Friday, February 4, 2011 10:35 AM
Sunday, February 6, 2011 8:54 PM
Monday, February 7, 2011 10:00 AM
Quote:After all, why struggle and make something of yourself when these pill can make you important and laugh from the top shelf
Monday, February 7, 2011 10:01 PM
Tuesday, February 8, 2011 5:29 AM
Wednesday, February 9, 2011 2:06 AM
Quote:Originally posted by Magonsdaughter: Amazing story, Frem. You should write a book.
Wednesday, February 9, 2011 3:52 AM
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