Monday, May 14, 2012

Why would psychiatry be better off without a psychiatric classificatory system such as DSM?

I thought it might be helpful to explain a little more why I think DSM-5 shouldn't go ahead. As I've said previously (eg. see earlier post), I am supporting the campaign to abolish psychiatric diagnostic systems. This campaign 'No more psychiatric labels' gives its rationale on its website.

The World Health Organisation started classifying the causes of death in the International Classification of Diseases (ICD). In the sixth revision it extended its classification to causes of morbidity as well as mortality and a chapter was added for psychiatric disorders (which don't cause death as such). The americans have always run a parallel DSM system. ICD-9 and DSM-II were essentially the same.

Criticism of psychiatric diagnosis led to the DSM-III revision, which attempted to define psychiatric disorders using operational criteria. Although it may have been technically atheoretical in its approach, it encouraged a biological understanding of mental illness as due to brain disorder. The misguided hope has been that reliable diagnoses will equate with standardised biological tests developed by advancing neuroscience (eg. see blog by Allen Frances, who has also been critical of DSM-5 because of its potential expansion of the boundaries of psychiatric diagnoses). DSM-IV abolished the distinction between organic and functional disorders as they are all seen as brain disorders (see previous post).

There were of course diagnostic systems before ICD-6 and DSM-I, but it is the authority attached to diagnostic descriptions since DSM-III that causes problems. However important classification may be for scientific communication, it is also essential to realise that diagnosis is also about the reasons why a person has developed problems. Focusing on a single word entity distracts diagnosis from obtaining this personal understanding.

Idealised diagnostic descriptions are not entities as such. This truth has been lost in the pursuit of DSM-5, which should be abandoned. There are alternative ideas about comprehensive diagnosis which could be developed (eg. see World Psychiatric Association (WPA) conference report). Allen Francis has recently suggested in NYTimes that a new organisation is needed to take over from the American Psychiatric Association, but I'm not quite sure why he doesn't consider WPA.


George Dawson, MD, DFAPA said...

Alternate diagnostic systems are already out there - even in the US. There is the system invented by Johns Hopkins. There is the Psychodynamic Diagnostic Manual or PDM - the product of collaboration between 6 nonpsychiatric organizations. All of these groups including international organizations seem to be suggesting that a classification system is needed. Many psychologists treat people based on the basis of test results. There is obviously no obstacle to other systems of comprehensive diagnosis.

In fact, McHugh and Slavney in their NEJM editorial this week discuss the difference between checklist diagnoses and comprehensive assessments and they correctly conclude that checklists "deprive psychiatrists of the sense that they know their patients thoroughly."

The problem with demagoguing the DSM is that it takes the clinical method and training used by psychiatrists out of the loop and caricatures psychiatric treatment.

YourVATnews said...

Why We Should be Sending Some Psychiatrists and Some Individuals at Drug Companies to Jail

The World Health Report 2001 explains that one in four people suffer from a mental illness. That means that mental illness is effecting hundreds of millions of individuals around the Globe. If you’re a business – providing therapy to individuals inflicted – does not make a very interesting business model because – of the high staff costs involved – and because such a model would mean a lot of competition. A medicine based approach – does provide a scalable business model.
It is of no surprise – that this is exactly the strategy – that big business has chosen. For almost all mental illness – there is a medicine based approach.
I am a psychosis sufferer and the side effects of this medicine based approach has been detrimental to my well being. In the past psychosis sufferers have received heroine, opium and cocaine for example. These solutions were all introduced by drug companies – as the best solution for society. Today there are anti-psychotics. The side-effects are really nasty of these drugs. Furthermore, a scientifically proven method called: Open Dialogue – from Finland has been around for more than 20 years. However, this understanding – is being purposefully kept – from other psychiatrists, policy makers and patients. Because, it is a therapy based approach – that does not provide an interesting business model. Now, this understanding is slowly spreading.
With depression it is no different. The World Health Organization estimates that worldwide there are 350 million depression sufferers (Fact Sheet April 2016). The answer – from drug companies is coming up with anti-depressants. From 1999 to 2012 the percentage of Americans on antidepressants increased from 6.8% to 13%, according to a report published this week by the Journal of the American Medical Association (JAMA). Also anti-depressants can have detrimental side-effects. However, it is becoming more and more apparent – that alternative treatments – are similarly effective – without medication. Several studies show that psychotherapy (particularly cognitive therapy, behavioral activation, and interpersonal therapy) compares favorably with medication in the short-term, even when the depression is severe, and appears superior to medications over the long term (Antonuccio 2002). Again, this does not make a great business model for drug companies.
Drug companies – especially their marketing department – have come up with strategies – to make drug use more prevalent and combat – increased understanding – that effectively – do not involve side effects from drugs. As an example – at psychiatric wards around the world – psychiatrists are stimulated – not to take the what they call incomprehensible communication of psychosis sufferers seriously – although it has been proven – Open Dialogue – that by doing so psychotic levels are lowered. Thus, more medication is necessary – and medication becomes the only alternative from coming out of a black hole.
Academics around the globe have been hired by drug companies for their strategies. Governments have been tricked – or bought. Mental hospitals – chose strategies – to keep patients ill – since the science is now out there – so they are also to blame.
I think it is time we start sending a lot of these crooks to jail for crimes against humanity. Especially – because – only now it is being more and more scientifically proven that love, understanding and healthy choices – in almost all cases solves mental illness. Has this understanding been around, since the beginning of time and has there been a lot of scientific misleading of humanity! I know the latter – but I can’t scientifically prove it!