APA Leading the Charge Against ‘Medicalizing’ DSM-5

By James Bradshaw, Senior Editor
January 16, 2012

APA Leading the Charge Against Medicalizing DSM-5The American Psychiatric Association (ApA) plans a third – and final – comment period sometime this spring for voicing concerns about the proposed rewrite of the Diagnostic and Statistical Manual, (DSM), but members of the DSM-5 Task Force need not wait that long to learn how outraged thousands of mental health providers are by many of the proposals.

The revised DSM is scheduled to be published in May 2013, and for most of the more than 10 years the mental health “bible” has been under review by the ApA the major complaint was the secrecy surrounding the work.

Then as information started becoming available, especially last year after the task force launched an information website – www.DSM5.org – that outlines many revisions being considered, the furor changed from “why are you hiding what you’re doing” to “why in hell would you do that?” Divisions of the American Psychological Association (APA) are leading the charge to rein in changes they believe will lower the threshold of mental disorders to the point that sadness at the loss of a loved one could be diagnosed as major depressive disorder and all mental disorders could be viewed as biological phenomena calling for prescribing psychoactive drugs.

A petition was launched in October by Division 32, the Society for Humanistic Psychology, with input and backing from several APA practice divisions as a critical open letter to the DSM-5 Task Force. It is gaining thousands of signers every month from all fields of mental health providers, including counselors, social workers and many psychiatrists.

One psychiatrist highly critical of the proposed revisions is Allen Frances, M.D., who was chairman of the DSM-IV Task Force and is a professor emeritus of the Department of Psychiatry at the Duke University School of Medicine.

In an interview with Psychiatric Times, an independent publication that like The National Psychologist is not affiliated with or beholden to any professional association, Frances recommended the petition as “an extremely detailed, thoughtful and well written statement that deserves your attention and support.”

Frances said the letter

“summarizes the grave dangers of DSM-5 that for some time have seemed patently apparent to everyone except those who are actually working on DSM-5. The short list of the most compelling problems includes: reckless expansion of the diagnostic system (through the inclusion of untested new diagnoses and reduced thresholds for old ones); the lack of scientific rigor and independent review; and dimensional proposals that are too impossibly complex ever to be used by clinicians.”

The complete text of the letter, which can be signed online, is located at www.ipetitons.com/petition/dsm5.

The opposition has become international. In December, the British Psychological Society with almost 50,000 members endorsed the petition, joining 36 other mental health organizations, including 14 APA divisions. Groups in Europe, South American and Australia also were organizing signers and one group in Barcelona reported gathering more than 5,000 signatures on its petition website.

Heavy in detail, empirical evidence and professional logic, the APA’s position echoes many complaints voiced earlier last year by the British Psychological Society, which issued a statement saying in part:

“The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation (sic) of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation. … We believe that classifying these problems as ‘illnesses’ misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our well- being and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the experiences and learning through our lives.”

Many complain that the proposals so pathologize normal human actions that an unruly child’s temper tantrum could be labeled “disruptive mood dysregulation disorder” or a mother’s attempt to turn a child against the father in a custody dispute could be found to be suffering “parental alienation disorder.”

However exaggerated some of that hyperbole might be, the overriding concern is that too many people will be prescribed unnecessary and potentially harmful medications.

Opposition to such broadening of mental disorder definitions is not limited to those in the health field. The majority of psychologists and often the entire field of psychology are viewed as liberal, but revelations about the proposed revisions are drawing fire across the political spectrum, including the CATO Institute, a conservative think tank headquartered in Washington, D.C. CATO is concerned that lowering the diagnostic threshold for many mental disorders could create an avalanche of claims against employers under the Americans with Disabilities Act, the Family Medical Leave Act and workers’ compensation laws.

CATO pointed to behavioral liabilities employers already face, including a trucking company that was sued for not hiring drivers with a history of drinking problems. The online comments did not specifically recommend that employers or management personnel consider signing the APA petition, but it included an active link to go to the petition site.

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