Davies asked Frances why he failed to omit from IV the huge numbers of DSM-III-R disorders that Frances described as eccentric and having "remarkably weak scientific support" (Davies, 2013, 51). Frances' response made no sense, but Davies' point was that absence of good scientific support should have led to their removal.
Revealingly, Frances has said that although "we cannot develop a useful definition for the general concept "mental disorder'"we can quite easily define each one of the specific mental disorders" (Frances, 2013, 23). By that logic, as long as one can define fear, horse, table, and freedom, although there is no way to determine whether or not they are all mental disorders, it is fine to group them all under that rubric. This approach leaves wide open the door to what Gomory, Wong, Cohen and Lacasse (2011) have described, which is that "mental illness" is applied to the many kinds of behavior that have become the targets of a "biomedical industrial complex."
False Portrayal as Helpful and Not Harmful. A diagnostic system that is not reliable cannot be valid. In his Scientific American article, Jabr quoted without question a psychiatrist who claimed that psychiatric diagnosis has increased in reliability (2012), but this is untrue. It had long been known that two therapists using the DSM were not likely to agree on what diagnosis to give a patient (Kirk and Kutchins, 1992; Caplan, 1995). If two therapists diagnose a patient differently, which label should be used to decide how to treat the person and thus, ideally, reduce their suffering? Also, a given patient's labels are often changed many times over the course of their lives, including many that are defined as lifelong conditions. Yet not only Frances but also many the APA presidents over the decades have publicly boasted about the good reliability and helpfulness of their profit-making manual. [3]
After I revealed publicly what I had learned about the unscientific production of IV, and that its leaders denied that it caused harm despite knowing it did (Caplan, 1995), I began hearing from people who had experienced damage that cascades from that first step of being diagnosed. Therapists almost never disclose these to their patients that psychiatric labels are unscientific, are unlikely to be helpful in reducing their suffering, and carry major risks of harm, so almost no patient ever gives informed consent to receiving a label. There is the pervasive fiction that however the therapist diagnoses you, the treatment follows from the label and will likely reduce your suffering and not harm you. Forms of harm include but are not limited to plummeting self-confidence and skyrocketing self-doubt; loss of hope, employment, health insurance, credibility in legal proceedings and other settings, custody of one's children, security clearance, and the right to make decisions about one's medical and legal affairs; having one's real physical illnesses or injuries explained away as figments of one's imagination; and serious physical damage and even death from the negative effects of psychotropic drugs (Caplan, 2012a, 2012b; Whitaker, 2010). I coordinated a series of 10-minute videos of stories of harm are on Youtube under the collective title, "Watch the Stories of Harm the APA Refused to Hear," and dozens more written stories are available at psychdiagnosis.weebly.com
DSM-IV appeared in 1994 and its minimally altered sequel IV-TR in 2000, but not until 2009 did Frances publicly express concerns about diagnosis causing harm, having asserted until then that the manual was helpful (2013). His mention of harm began in relentless and virulent attacks on DSM-5 (e.g., 2012c, calling out the 5 leaders for failing to create a safe manual), as recently as 2013 expressing alarm that expansion of the net of mental disorders would expose people to "unnecessary medicine with possibly dangerous side effects," and drug companies would be "licking their chops" to exploit "inviting new targets for their well-practiced disease mongering" (2013, xiv; see also Davies, 52). (Greenberg [2013, 99] with understatement describes Frances's failure "to use his clout" over the years to speak out about massive increases in use of and harm from psychiatric drugs.) Recall that he oversaw the greatest expansion of the manual. It strains credibility that for the first 15 years after IV appeared, up to 2009, he had had no idea that the public needed to be warned of harm from labels, and I am surely not the only one who had informed him about instances of harm (Caplan, 1995). It is poignant to think how much suffering he and every post-IV APA president and trustee could have prevented, had they come clean with other professionals and the public, saying, "These labels are not based in science, and using them can be damaging." But Frances claims he was floored by the three diagnostic epidemics he admits grew from IV, and although he calls his book part mea culpa (xviii), it is actually a monumental mea excusa, since he lays the blame for harm on a raft of others who "misused" it (xiv) -- Pharma, other psychiatrists and therapists and non-psychiatrist physicians, patients themselves, researchers, consumer groups, the internet, and the media (29). His list of kinds of harm is scanty (195) and gives no indication that anyone before him had called attention to the risks. Furthermore, because of the unregulated status of psychiatric diagnosis and thus the lack of a central, mandatory registry showing who receives what labels, it is impossible to know how many other epidemics of labeling there have been besides the three Frances names.
A kind of harm unmentioned in debates about the manual is that DSM labels are the very foundation for "practice guidelines" on the APA website, where DSM categories are the organizing entities for treatment recommendations. Thus, therapists are told how to treat people based on unscientifically constructed categories, [4] creating insurmountable problems for research on treatment effectiveness, and the guidelines are packed with recommendations for drug treatment (specifically noting that off-label prescribing is "permitted and common" [5] ) and even electroshock. The authors of the guidelines have astounding numbers of drug company connections. [6]
Frances and the APA leaders might at any time before the 2009 attacks on DSM-5 have taken steps to prevent harm. I would have welcomed their joining my 2005 petition calling for Congressional hearings [7] about psychiatric diagnosis (begun at psychdiagnosis.net, now in expanded form at https://click here), but Frances did not propose Congressional action (action in general, not hearings specifically) until 2012 (Frances, 2012b). I issued a public invitation for Frances to endorse our requests for the APA to create a system for recording (indeed, they ought to solicit) reports of harm from diagnosis and for using some of their $100 million in profits from IV for redress, to try to make whole some of those whose lives have been destroyed because they were labeled (Caplan, 2013a ). He did not respond to the invitation. About a month after I suggested blackbox warnings on all copies of the DSM and anything related to it (Caplan, 2012b), Frances suggested black-box warnings solely for the few diagnoses in 5 that he criticized (Frances, 2012d).
While on Frances' committees in the late 1980s, I expressed concerns about the vast pathologizing of women as having "Premenstrual Dysphoric Disorder." The European Union's equivalent of the FDA has declared that the research shows it is not a real entity. I had told Frances that in light of our shared the aim of alleviating suffering, and since I knew many women had suffered because of getting this label, I would feel better if I knew at least that more women were being helped than harmed. He replied that there was no way of knowing that (Caplan, 1995). But gathering such information is precisely what science is for.
The uninformed and/or motivated rewriting of history has usually taken the form, in recent books about DSM-5, of omitting the history of significant attempts by those outside the APA to prevent and redress harm. But even authors of most of the recent books who do not omit that history make the mistake of identifying as the first anti-DSM petition one that was created in 2012, wherein 5's editors were asked to submit their proposals to external review. No mention is made of the first DSM petition, which I created and circulated in the mid-1980s and which included signatures from individuals and major organizations representing more than six million people but which had little effect on the actions of Robert Spitzer and the other editors who prepared DSM-III-R (Caplan, 1995). I watched excitement grow as the 2012 petition was signed by 12,000 or so people and many organizations; but I felt sad about all the energy going into that new petition and about the hope that it would bring a review composed of research methodology experts with no connection to the APA or drug companies. My sadness was because over decades I had seen that DSM leaders claim to have brought in huge numbers of outside consultants, as they ignored input from those consultants when it failed to suit them. As expected, the 5 editors ultimately replied to the 2012 petitioners that they already had external reviewers and took no action as a result of that petition. Disappearance from history of the earlier petition was damaging, because energy put into the recent one could more productively have gone into taking action that might have been more likely to be productive, since it has long been clear that change from within APA would not happen, and false hopes would not have been aroused.
I organized the filing of nine complaints with the APA's Ethics Committee (Caplan, 2012a, 2012b). The complaints were from people harmed by diagnosis, and the respondents they named were the heads of the DSM-IV and every one of its Presidents and Trustees from 1988 -- when preparation of IV began -- to the present. With one exception, every president during that time had either publicly said nothing about psychiatric diagnosis or had baldly lied about its reliability and/or validity. [8] Had they publicized the truth, therapists would have acted differently, patients would have been better-informed, and the public would have had fair warning about at least some dangers of being diagnosed. The APA dismissed the complaints on spurious grounds, with no attention to their merits, and refused to disclose the names of the members of the APA Ethics Committee who made those decisions (Caplan, 2012b).Subsequently, five of the APA complainants filed complaints with the Office of Civil Rights of the Department of Health and Human Services, the agency where some regulation of diagnosis ought to be done. In those, which I assisted in preparing, the complainants argued that civil rights violations had occurred pursuant to the Americans with Disabilities Act, according to which it is discriminatory to treat someone as disabled when they are not. The complainants had been variously grief-stricken, frightened, and despondent due to losses and attacks that would understandably cause severe upset and which should not be called mental illness, but they had been psychiatrically labeled, thus treated as disabled although they were not, and they had suffered losses and damage as a result. Their losses and damage ranged widely, from plummeting self-confidence to loss of employment and scholarship money to interruption of their education to loss of custody of a child to harm due to psychiatric drugs, the latter including the death of a complainant's loved one from the drugs' effects. The OCR of HHS summarily dismissed them all, we asked for reconsideration, and the complaints were again dismissed with finality.
We have filed some complaints with the Federal Trade Commission (FTC), because the DSM is a product sold across state lines, falsely advertised, and causing harm. The FTC guidelines include the information that the FTC does not act on each complaint they receive but may act if they receive some unspecified number about a particular product.
False Claims to be Transparent: Lies, Deception, and Both Sides of the Mouth
DSM-III-R editor Spitzer (2009) criticized the 5 editors for following insufficiently transparent procedures, a claim Frances then made repeatedly, contrasting their procedures with the transparent ones he claimed to have used for DSM-IV (Frances, 2013, xvii, 70; Frances, 2012b). The editors of 5 proclaimed that their work was transparent to an unprecedented degree, because they publicly posted drafts online, where anyone could comment, and they said they read every comment. What they did not say, and what such journalists as the writer of a Scientific American article (Jabr, 2012) who described the commenting process failed to address was that they were no more required than were the editors of previous editions to make changes based on legitimate critiques.
One striking example of false portrayal about transparency (there are many) concerns III-R, IV, and 5 and illustrates the pervasive and longstanding pattern of deception in the manual's history. [9] In the mid-1980s, Spitzer proposed adding "Premenstrual Dysphoric Disorder" (PMDD) to III-R, but after massive opposition expressed in that first petition at that time (Caplan, 1995), he announced that he would create in the manual an appendix for categories requiring further study, to contrast with the allegedly scientifically-supported categories in the main text. His public pronouncements failed to reveal that PMDD would also be listed in III-R' s main text (under Mood Disorders), and there was no warning in the appendix against applying the label to patients. For IV, Frances had named me a consultant to the PMDD work group, so I saw the review of research that was written by the PMDD committee members (all or most of whom received Pharma funding for research about drugs aimed for marketing for PMDD: See Caplan, 1995, and Cosgrove et al., 2006, for some of these details.). Their review included hundreds of studies, most of which they concluded were unrelated to the question of whether there was a premenstrual mental illness at all (in contrast to, say, bloating or breast tenderness). They accurately described the few relevant studies as preliminary and filled with methodological errors (Caplan, 1995). One might have expected the committee to recommend removal of PMDD from the manual, especially given that Frances claimed that for IV, prolonged disagreements about data for a category "meant that the scientific literature was too sparse or ambiguous to support change" (2013, 71). But the committee told Frances they could not reach consensus about what to do, and he appointed two other people to make the decision. When I asked him who those two people were, he refused to tell me, saying if he did, they would be "deluged with questions" (Caplan, 1995). Many journalists apparently asked who they were, and when he finally announced their names, it was evident that neither had expertise about premenstrual matters, one was Nancy Andreasen, a longtime DSM insider and colleague of Spitzer (Spitzer had created the category), and the other was A. John Rush, who had conducted Pharma-funded research about depression. When IV was published, Spitzer announced on "The Today Show" that PMDD would only continue to be in the provisional appendix, but in fact it was also in the main text, switched to the Depression section. In their recent book, Kirk et al. say Frances worried about "embarrassing post-publication surprises" 2013, 188) in 5, as if there had been none in previous editions, but as illustrated, he and Spitzer had their shares. [10] Continuing the tradition of deception, in perhaps the first major advertisement for DSM-5, one of the specific selling points was that PMDD was going into the manual for the first time. The lies are multi-generational.
Frances claims that financial interest compromised no decisions for IV, yet the choice to list PMDD under Depressive Disorders reeks of financial interest. Relevant, too, is that a primary PMDD work group member for IV accompanied an Eli Lilly representative to a meeting with the Food and Drug Administration to convince them to approve Prozac to treat PMDD (which had never been shown to be a valid entity: Caplan, 2005), garnering Lilly enormous profits. And the tallies by Cosgrove, Krimsky, and their colleagues showed huge numbers of IV task force members to have financial ties to drug companies (2006).
Next Page 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10
(Note: You can view every article as one long page if you sign up as an Advocate Member, or higher).
2
1
1
