ot: DSM psychiatry manual's revision-secrecy criticized

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*DSM psychiatry manual's secrecy criticized*

The Diagnostic and Statistical Manual of Mental Disorders is being

revised under a cloak of confidentiality. Critics say the process needs

to be open, and cite potential conflicts of interest.

By Ron Grossman

December 29, 2008

http://www.latimes.com/features/health/la-na-mental-disorders29-2008dec29,0,3923\

115.story

Whether revisions to the bible of mental illness should be carried out

in secret might seem like an academic question.

But the issue carries real weight for parents desperate to address

children's difficult behavior or people in distress over their mental

state. It also speaks to citizens' concerns over news accounts of an

overmedicated America and of the troubling financial links between some

psychiatric researchers and the pharmaceutical industry.

An update is underway for the fifth edition of the Diagnostic and

Statistical Manual of Mental Disorders, known as the DSM, which defines

the emotional problems for which doctors prescribe drugs and insurance

companies pay the treatment bills. Psychiatrists working on the new

edition were required to sign a strict confidentiality agreement.

Critics contend that the American Psychiatric Assn. should allow outside

observers to review the scientific debate behind new and revised diagnoses.

Among the most prominent to speak out is the editor of the manual's

third edition, Dr. Spitzer, hailed by peers as the most

influential psychiatrist of his generation. If the DSM is often called

the profession's bible, then the DSM-III is the King Version.

Released in 1980, it set the standard by which others are measured.

Recently, Spitzer broke ranks by publishing an open letter to the

profession protesting the confidentiality mandate.

" If you don't know what goes on at someone's meetings, they're suspect

of having a conflict of interest, " the Columbia University professor

said in an interview.

The profession is already confronting that issue through revelations

that academics in the field are earning tens of thousands of dollars in

consulting fees from drug companies. The financial links between the

drug industry and the psychiatric community have sparked a congressional

investigation headed by Sen. E. Grassley (R-Iowa).

Officials with the APA counter that the psychiatrists working on the DSM

revision are limited to $10,000 annually in fees from drug companies.

The association says " transparency " is the byword of those overseeing

the process.

Darrel Regier, who heads the APA's research arm, said the critics are

failing to recognize progress in the field. " The field of psychiatry has

gone from an ideology to a scientific pursuit, " he said. The DSM grew

out of a guidebook used by the military during World War II. Afterward,

it was revised for general use and subsequently enlarged.

When it first appeared in the 1950s, psychiatry was dominated by Freud's

model of psychological suffering, one that was resolvable by talking out

the conflict with a therapist. Yet even then, drugs were appearing for

relief of psychotic symptoms, and leadership in the profession has since

passed to psychiatrists with an alternative model: biology and genetics

as the source of emotional problems.

As the field has changed, the number of disorders in the DSM has tripled

to 300, an increase paralleled by the rise in sales of drugs that

pharmaceutical companies and psychiatrists tout as remedies for

emotional suffering.

Some critics suspect that a quest for profits has encouraged the field

to create mental illnesses out of personality quirks.

In his recent book, " Shyness: How Normal Behavior Became a Sickness, "

Lane traces how shyness morphed from a character trait into

a pathological condition called " social phobia, " which the DSM defines

as " fears that he or she may do something or act in a way that will be

humiliating or embarrassing. " With disorders so broadly drawn, Lane

wonders, who among us is sane?

It's an apt criticism, says Kupfer, who is shepherding the DSM's

revision.

" One of the raps against psychiatry is that you and I are the only two

people in the U.S. without a psychiatric diagnosis, " said Kupfer, head

of the psychiatry department at the University of Pittsburgh.

Kupfer said he hopes to reduce the number of diagnostic categories in

the forthcoming edition of the DSM, scheduled to appear in 2012.

He argues that scientific progress comes from formulating ideas, then

seeing if others can shoot them down. If currently listed maladies fail

that test, they'll be dropped, Kupfer said.

Meanwhile, Lane -- who has become something of a thorn in the side of

the psychiatric community -- has irked some by obtaining the working

papers of psychiatrists who produced the DSM-III and making plans to

post them on his website.

Some of his finds read less like scientific discourse than like shtick

from a Catskills comedian.

One syndrome under discussion at the time was " chronic complaint disorder. "

Its supposed sufferers were largely " of Eastern European ancestry " and

revealed their malady when asked how things are going.

" In those cases, " the psychiatrists wrote, " the pathognomonic expression

becomes, 'Oy vey, don't ask.' "

rgrossman@...

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