APA Attempts to Defend Itself

December 6, 2011
Allen Frances, MD

,
Allen Frances, MD

This blog is a follow-up to an earlier post. The great news is that there is an active public debate on DSM-5.

This blog is a follow-up to an earlier post. The great news is that there is an active public debate on DSM-5. The leadership of the American Counseling Association (ACA) recently sent a thoughtful letter to the leadership of the American Psychiatric Association(APA) that summarizes the most serious flaws in the DSM 5 and recommends the steps necessary to regain its lost credibility and earn the support of potential users. The letter has tremendous force because the ACA represents fully 20% of all the mental health professionals who will eventually  have to decide whether to use  DSM-5 (it is available at: http://www.counseling.org/Resources/pdfs/ACA_DSM-5_letter_11-11.pdf).

The APA's response to ACA is long-winded, something of a classic (available at: http://www.dsm5.org/Documents/DOC001.pdf). The cloudy confusion in the APA response deserves more detailed deconstruction in later blogs-but for now, let's maintain a tight focus on what is missing-5 straight answers to these 5 simple questions:

1) Why is APA not willing to have an independent external scientific review of questionable DSM-5 proposals- especially since its own internal, super-secret review process has been so badly discredited? APA response: There have already been multiple layers of review from its DSM-5 workgroups, task force, advisors, and scientific review group. The claim is that this constitutes an "independent" review, simply because few of the people involved are paid APA employees. This doesn't pass the most forgiving smell test.

2) Since the DSM-5 suggestions will all broaden the definition of mental disorder, why should we not worry about diagnostic inflation and the massive mislabeling of normal people as mentally ill?

3) Won't this diagnostic inflation exacerbate the already rampant over-prescription of psychotropic medications (especially by primary care doctors, especially antipsychotics, especially to kids)?

4) Why should we not worry about the unintended forensic complications of a sloppily written DSM-5 containing suggestions that are obvious targets for forensic misuse?

5) Won't the many small, needless, and arbitrary changes in DSM-5 complicate future research efforts and make impossible the interpretation of data collected before versus after DSM-5?

APA's response dodges all 5 questions. Perhaps this is because DSM-5 is so fundamentally flawed that it is defensible only by smoke screen. And experience has proven that DSM-5 cannot self correct-its current version is virtually equivalent to the frightening first draft posted in February 2010. The calls for public comment have turned out to be no be more than sham, public relations window dressing with no substantive impact on product. It is by now crystal clear that APA will produce a safe and scientifically sound DSM-5-only if its users rise up and force it to. Concerned? You can help by signing the petition to reform DSM-5 at http://www.ipetitions.com/petition/dsm5/.