Wednesday, May 09, 2012

Occupy APA

I went to a meeting of the radical caucus of the APA last Sunday in Philadelphia, where I was attending a conference (see previous post). I suppose the radical caucus could be seen as the US equivalent of the Critical Psychiatry Network. It was interesting to see that similar issues were raised.

A particular issue currently is the DSM-5 revision. As I have mentioned previously (see post), I have signed up for the campaign to abolish psychiatric diagnostic systems like DSM. I think it would help psychiatry to be without a diagnostic system for a while. It managed without one until 1948. The American psychiatric system has become very dependent on DSM for billing purposes, but I'm sure the insurance companies could develop an alternative system unrelated to DSM. After all, in the UK, clusters have been created for the introduction of payment by results without requiring an ICD diagnosis.

The meeting was split on the issue of the need for mental health legislation. As I've said before (see previous post) I think it's important revolutionaries and reformers work together. In the UK context, there is need for further reform of the Mental Health Act following the 2008 amendment. For example, there are ethical problems about enforcing community treatment in a capable patient. I think there is also a need for further safeguards in the use of ECT in a patient who is not consenting to treatment. But, unlike some, I do see a need for legislation.

For further reflections on the meeting, see Brad Lewis's post on Mad in America blog.

8 comments:

George Dawson, MD, DFAPA said...

American insurance companies are interested in DSM diagnoses only so far that it allows them to deny payment (no DSM dx), deny services (not the correct dx for the service), or to allow their own reviewer to try to "manage" care remotely on patients that they have never seen, never will see, and generally have no clue about. That is the only interest the insurance industry has in any diagnostic system DSM or otherwise.

It will be very interesting to see what happens if the industry is allowed to pay based on outcomes. It is basically a way to prioritize business interests over clinical interests.

Atariana said...

Hi,
I am not a psychiatrist, therefore not quite understand about the DSM/ICD systems. Please can someone explain why are those systems so bad...beside the American insurance company use it (DSM)as a billing system.
Am I right to believe that DSM/ICD are both use to determine the severity of a mental illness, therefore getting rid of them may somehow create choas in the psychiatry world in term of Dx criteria.
Why is psychiatry better without DSM/ICD systems??

Atariana said...

Dare I ask (I am curious) - are those in favour of getting rid of DSM/ICD systems are senior pscyhiatrist ( in term of age & years of practice)? If that is the case, it would be intersting to have both side of opinions between the senior and the junior?

Anonymous said...

If you don't support my right to human rights Duncan Double, screw you, we CAN NEVER work together.

You see the need legislation forcing the pseudoscience of psychiatry on people, I see the need to stop even listening to you, reading your blog, at all.

If you can't see how immoral forced drugging, forced electroshock, and psychiatric 'pre-crime' detention is, then seriously, you're not worth listening to.

Duncan Double said...

I don't think I'm not supporting your human rights, anonymous. Some people do lack capacity when mentally ill, don't they?

Anonymous said...

Well you've defined them as "mentally ill" and said they "lack capacity" and you're the powerful one so you win. You outvoted them.

Your blog is one long chronicle of why psychiatry is a pseudoscience. Why should it be legal to force this pseudoscience on me?

If I'm human, I deserve human rights.

People always have the capacity to say NO when they are conscious, regardless of whether you label their thoughts 'ill' or not.

I say NO. You say that NO will not be listened to if I am legally robbed of my 'capacity' by your defining it out of existence.

If you aren't prepared to support us having inalienable human rights to own our own bodies, you don't support our human rights.

Duncan Double said...

I'm not questioning your competence. You obviously have inalienable rights to your own body. But some poeple do lose capacity at times. For example, does a demented person not have diminished ability to make decisions?

Atariana said...

Hi Anonymous,

I m sorry you are upset about Duncan Double's blog. You are right - everyone deserve their human right. I completely agreed with you. I don't like how some of the mentally ill being treated at times, but Duncan Double is alright.
Due to the nature of my work - I have met Duncan Double few times ( although he doesn't know who I am because Atariana is not my given name)- he is OK compared to many. Duncan Double can be wired but he is quite kind and I believed he is fair to his patients.

I wish you well.