x Abu Dhabi, UAEWednesday 26 July 2017

Critics say psychiatric diagnostic manual lacks credibility

New edition under fire for listing mundane behaviours as diagnosable mental illnesses.

CHICAGO // The new version of the world's most widely used psychiatric guide to mental disorders says grief soon after a loved one's death now can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain forgetful moments for the ageing are called "mild neurocognitive disorder."

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common problems into mental illnesses in a trend they say would just make the "pop-a-pill" culture worse.

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

The psychiatric association was slated to formally introduce the nearly 1,000-page revised version tomorrow in San Francisco. It will be the manual's first major update in nearly 20 years, and a backlash has taken shape in recent weeks.

Two new books by mental health experts, Saving Normal and The Book of Woe," said the manual had lost credibility.

A British psychologists' group criticised the DSM-5, calling for a "paradigm shift" away from viewing mental problems as a disease. An organisation of German therapists also attacked the new guide.

The head of the United States National Institute of Mental Health, Dr Thomas Insel, said the book lacked scientific validity.

The manual's release comes at a time of increased scrutiny of health care costs and concern about drug companies' influence over doctors in the US. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

Many of the 31 task force members involved in developing the revised guidebook had financial ties to makers of psychiatric drugs, including consulting fees, research grants or stock. Group leaders dismissed that criticism and emphasise they agreed not to collect more than US$10,000 (Dh36,731) in industry money during the calendar year preceding publication of the manual.

"Way too much treatment is given to the normal 'worried well' who are harmed by it; far too little help is available for those who are really ill and desperately need it," Dr Allen Frances wrote in Saving Normal. He is a retired Duke University professor who led the psychiatric group's task force that worked on the previous guide.

He said the new version added new diagnoses "that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders".

Previous revisions were also loudly criticised, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual - including autism, attention deficit disorder and bipolar disorder - and billions of dollars spent each year on psychiatric drugs.

The group's 34,000 members are psychiatrists - medical doctors who specialise in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have taken the tensions to a new level.

Dr David Kupfer, the chairman of the task force that oversaw the DSM-5, said the changes were based on solid research and would help make sure people get accurate diagnoses and treatment.

Dr Jeffrey Lieberman, the association's incoming president, said challenging the handbook's credibility was "completely unwarranted". He said the book took into account the most up-to-date scientific knowledge.

But Dr Insel, wrote that the guidebook was no better than a dictionary-like list of labels and definitions.

He said he favoured a very different approach to diagnosis that was based more on biological information, similar to how doctors diagnose heart disease or problems with other organs.

Yet there is scant hard evidence pinpointing what goes wrong in the brain when someone develops mental illness. Dr Insel's agency only two years ago began a research project to create a new way to diagnose mental illness using brain imaging, genetics and other evolving scientific evidence. That project will take years.

Advocacy groups threatened protests and boycotts at this week's meeting of the psychiatric association.

"The psychiatric industry, allied with Big Pharma, has massively misled the public," the Occupy Psychiatry group said. Organisers include a lawyer, Jim Gottstein, who has long fought against overuse of psychiatric drugs.

The new manual "will drastically expand psychiatric diagnosis, mislabel millions of people as mentally ill, and cause unnecessary treatment with medication," says the website for the Committee to Boycott the DSM-5, organised by a New York social worker, Jack Carney.

Courtney Fitzpatrick, a committee member whose 9-year-old son died seven years ago while hospitalised for a blood vessel disease, said she had joined support groups for grieving parents, "and by no means are we mentally ill because we are sad about our kids who have died".