WHY NOT TELL THE WHOLE TRUTH, NAMELY, THAT SCIENCE REMAINS A STRANGER TO THE ENTIRE DOGMA OF PSYCHIATRY , AND NOT JUST TO ITS "NEW BIBLE" ?
by Benjamin Merhav
The article below - published by the Scientific American - is telling the truth, but not the whole truth about psychiatry. The whole truth is that science remains a stranger to the entire dogma of psychiatry, and not merely to its "new Bible" alone.
What then would you call in truth psychiatry, which purports to be a "medical specialty" ? The only possible answer is that it is a quackery, and because its "treatments" are imposed on its patient-victims, in flagrant violation of their basic human rights, for the benefit of Big Pharma and for the shrinks themselves, it is fascist too !
Here is the article :
http://blogs.scientificamerican.com/streams-of-consciousness/2012/05/08/science-remains-a-stranger-to-psychiatrys-new-bible/
By Ingrid Wickelgren |
May 8, 2012
|
By Ferris Jabr*
Part 2 of a series
In the offices of psychiatrists and psychologists across the country you can find a rather hefty tome called the Diagnostic and Statistical Manual for Mental Disorders (DSM).
The current edition of the DSM, the DSM-IV, is something like a field
guide to mental disorders: the book pairs each illness with a checklist
of symptoms, just as a naturalist’s guide describes the distinctive
physical features of different birds. These lists of symptoms, known as
diagnostic criteria, help psychiatrists choose a disorder that most
closely matches what they observe in their patients. Every few decades,
the American Psychiatric Association (APA)
revises the diagnostic criteria and publishes a brand new version of
the DSM. The idea is to make the criteria more accurate, drawing on what
psychologists and psychiatrists have learned about mental illness since
the manual’s last update.
The fat volume on top is still skinny on the science. Courtesy of Ferris Jabr.
In May 2013, the APA plans to publish the fifth and newest edition of
the DSM, which it has been preparing for more than 11 years. On its DSM-5 Development website,
the APA states that the motivation for the ongoing revisions was an
agreement to “expand the scientific basis for psychiatric diagnosis and
classification.” The website further states that
“over the past two decades, there has been a wealth of new information
in neurology, genetics and the behavioral sciences that dramatically
expands our understanding of mental illness.”
In other words, the APA intended to make the DSM-5 the most
scientific edition of its reference guide yet, which would be a real
boon for a book that has been routinely lambasted as fiction borne out
of convenience, rather than a solid clinical text grounded in research.
Now, only one year away from the planned publication of the DSM-5, most
psychiatrists have accepted that the APA’s initial optimism about
informing revisions with cutting edge science is well intentioned, but
premature. Most of the proposed revisions to current DSM criteria—many
of which are genuine improvements—are based not on insights from
genetics and neuroscience, but rather on clinical experience, prevalence
studies and plain old common sense. Indeed, many of these changes could
have been made years ago. (For more on these changes, see “Psychiatry’s ‘Bible’ Gets an Overhaul,” by Ferris Jabr, Scientific American Mind, May/June 2012.)
Cutting and Collapsing Categories
Consider, for example, that the DSM-IV organizes schizophrenia into six types, all of which the APA proposes eliminating
from the DSM-5. Why? Because these archaic subcategories were never
grounded in empirical research in the first place; they were just what
sounded good to the DSM authors of yore. In truth, these ostensible
types of schizophrenia probably do not exist. Similarly, the APA is nixing
three of the 10 current personality disorders, essentially
acknowledging that these were never legitimate illnesses in the first
place. So many people fit the criteria for more than one personality
disorder simultaneously that 10 varieties become superfluous.
Likewise, the DSM-5 collapses four of the five current pervasive developmental disorders—including
autistic disorder and Asperger’s—into a single category called autism
spectrum disorders, because there is so much overlap in their respective
criteria. None of these revisions are founded on recent revelations
from genetics and neuroimaging research. Study after study has failed to
discover a set of genes or unusual brain structures that reliably
identifies major mental disorders. Rather, these are changes that many
psychiatrists have been advocating for the past two decades based on
their everyday clinical experience, studies of illness prevalence and
the sense that some of the current criteria do not make sense. Despite
awareness of these flaws, the APA did not get around to updating the DSM
until now, the first substantial revision in 30 years.
One exception to the APA’s disappointed ambitions to base the ongoing
revisions on neuroscience are the proposed changes to addictions.
Scientists understand quite a bit about how the addicted brain differs
from a typical brain. The APA has proposed adding gambling disorder
to the DSM-5, in part because reward circuits in the brains of gambling
addicts light up in the same way as those in alcoholics and drug
addicts. Still, some researchers worry that the DSM will end up
sanctioning addictions to everything—gambling, sex, the
Internet—shifting focus to what people are addicted to from why addictions form in the first place.
Flaws in the Process
All the proposed revisions to the DSM-5 emerge from the task force:
27 scientists affiliated with the APA who sort through all the relevant
research literature. In the past, many psychiatrists have criticized
the APA for not creating an independent review committee to examine this
literature—a group of scientists who are not obligated to appease the
APA.
In January of this year, David Elkins, president of the Society for Humanistic Psychology, authored an open letter
to the APA calling for such independent review: “As you know, it is
common practice for scientists and scholars to submit their work to
others for independent review…Will you submit the controversial proposals in DSM-5 to an independent group of scientists and scholars with no ties to the DSM-5 Task Force or the American Psychiatric Association for an independent, external review?” [Emphasis theirs]
In a letter of its own, the APA responded: “There is, in fact, no
outside organization that has the capacity to replicate the range of
expertise that DSM-5 has assembled over the past decade to review
diagnostic criteria.”
Recently, the APA has mentioned here and there that it has in fact
created such a “scientific review committee,” separate from the task
force, but you will not find any satisfactory description of it or its
responsibilities on the DSM-5 Development website. Darrel Regier,
vice-chair of the Task Force, explained that the committee includes
about six scientists selected by the board of trustees, because “there
is no way you can have truly independent review,” and declined to say
more. Allen Frances, chair of the DSM-IV Task Force and the most
outspoken critic of the DSM-5, says that the APA only created this group
at the last minute in response to criticisms. “The scientific review
committee is not even transparent,” Frances says. “They report
confidentially to APA.”
Frances and other critics have pointed to a related flaw in the
ongoing revisions. Every time the APA revises the DSM, it conducts
“field trials” of new diagnostic criteria. These are dry runs of the
proposed revisions in clinical settings that test their reliability—that
is, whether two different psychiatrists using the new criteria reach
the same conclusion about a given patient.
Since 2010, the APA has been conducting field trials for the proposed DSM-5 diagnostic criteria. (For more on the results of the field trials, click here.)
Critics contend—and Regier confirms—that the trials fail to explicitly
compare the criteria suggested for the DSM-5 to that in the DSM-IV,
except in the case of post-traumatic stress disorder. That is like a
taste test in which the judges decide that a new diet soda is better
than its non-diet predecessor because everyone approved of the flavor,
even though the judges never bothered to directly compare the diet and
regular versions. Although in past revisions the APA has done such a
comparison, Regier says that this time doing so would double the size of
the survey, making it too costly and time-consuming to conduct. “You
just don’t do science that way,” Frances says."
(Emphasis in red added - B.M.)
