DSM-5, the newest edition of the American Psychiatric Association’s ‘Bible of Psychiatry’ will be officially released in May 2013 and is already available for presale. However, this edition of the DSM may not prove as profitable for the American Psychiatric Association (APA) as there is a growing international chorus of voices, many from within mainstream psychiatry, calling for a boycott of the DSM5.
This is the saddest moment in my 45 year career of studying, practicing, and teaching psychiatry. The Board of Trustees of the American Psychiatric Association (APA) has given its final approval to a deeply flawed DSM 5 containing many changes that seem clearly unsafe and scientifically unsound. My best advice to clinicians, to the press, and to the general public – be skeptical and don’t follow DSM 5 blindly down a road likely to lead to massive over-diagnosis and harmful over-medication. Just ignore the ten changes that make no sense.
MARTIN WHITELY (Trancript of speech in the Legislative Assembly, Parliament of Western Australia, 25 September 2012): I want to use this opportunity to talk about some very serious concerns I have about the direction of the mental health policy in Australia. My basic contention is that personalities, rhetoric and charisma are driving the direction of mental health rather than science and evidence.
“As opposed to the ‘ongoing disability’ or ‘impending doom’ assumptions inherent in the Americanisation and Preventative Psychiatry approaches, the Recovery approach is more optimistic about the capacity for recovery and less reliant on pills. It supports mentally ill patients with housing, educational, employment and psychosocial support – building blocks for a healthy and happy mind that can’t be replaced by drugs.”
A decade in politics has taught me it is rare for prominent people to acknowledge mistakes and even rarer for them to do everything in their power to correct them. And taking responsibility for past errors is especially problematic for members of the American medical profession who work within a blame avoidance culture created by the ever-present threat of malpractice suits. Special praise is therefore due to Dr Allen Frances the psychiatrist who led the development of DSMIV for his efforts to ensure that the mistakes of DSMIV are not repeated in the development of DSM5.
The following is an edited excerpt from a speech Martin Whitely MLA made in the Western Australian Legislative Assembly on Wednesday 25 May 2011
Mental Health was a centrepiece of the federal budget, with an additional $2.2 billion being identified over five years for mental health initiatives, of which $419.7 million was split between the Early Psychosis Prevention and Intervention Centre (EPPIC), and Headspace. An additional $2.2 billion for mental health is a good thing and to the extent that people such as Professor Patrick McGorry, Professor Ian Hickie and Professor John Mendoza, have contributed to putting mental health on the agenda, they deserve praise. However, I am concerned that the devil is in the detail. My criticism is not about extra funding but about the lack of an evidence base for the decisions that have been made.
No sensible person would argue against Australian of the Year, psychiatrist Patrick McGorry’s call for early intervention to prevent psychosis; unless of course you know the detail of what Professor McGorry has advocated as early intervention. Put bluntly, Professor McGorry has advocated the use of antipsychotics, with a host of serious potential adverse side effects, on the hunch that adolescents may later become psychotic.
Specifically Professor McGorry is a leading international advocate for the inclusion of Psychosis Risk Syndrome, otherwise known as Attenuated Psychotic Symptoms Syndrome, in the next edition of the clinically dominant Statistical Manual of Mental Disorders (DSM-V) due for publication in 2013. He acknowledges that ‘the false positive rate may exceed 50-60%’ nonetheless has justified the use of pre-psychosis drugs by arguing ‘all those identified are by definition seeking help and need some form of care’.