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Could DSM-5 Be Harmful to Your Mental Health?

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The APA diagnostic manual revision process, in the news recently over the definition of autism, holds other potential threats for women’s health. Elayne Clift investigates the gender issues in DSM-5.

Debbie N. (not her real name) was a college student in the 1990s when she traveled to the Mediterranean to recover from an abusive relationship. Partying hard, a cultural norm for her immigrant family, she was diagnosed schizophrenic. Back in the States, using alcohol and drugs to numb her pain, she entered Harvard where she earned a master’s degree. There, diagnosed bi-polar and prescribed Lithium (which permanently impaired her thyroid function), she was given anti-depressants and told she would require meds for the rest of her life. Now, after several hospitalizations and agonizing self-doubt, she is free of medication, owns her own business, and leads a healthy lifestyle based on rest, nutrition, exercise and meditation. “I consider myself to be a sensitive person who’s been through a lot of loss. I changed my lifestyle and took responsibility for my behaviors. I’m a survivor.”

Stories like Debbie’s are ubiquitous, and so troubling that as the new Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, is being prepared for release in 2013, clinicians formerly involved in its preparation are calling for major reform of the text that has driven psychiatric diagnosis and treatment for decades. Many of them will participate in “Boycott Normal,” a demonstration planned for May 5, when the American Psychiatric Association (APA) meets in Philadelphia and is likely to vote to go forward and publish the DSM-5.

“This is not a civil war between establishment psychiatry and so-called radicals,” says boycott organizer David W. Oaks, executive director of MindFreedom International. “We are trying to put the debate into a human rights framework because the DSM has been used to discriminate, to take away liberties, and to allocate resources. It’s a quasi-legal document written by a few hundred people voted on by rich white males.”

Dr. Allen Frances, who chaired the task force revising DSM-4, is among those psychiatrists now calling for reform, along with organizations like the American Counseling Association, the British Psychological Society, and a division of the American Psychological Association. But that effort focuses on the process of deciding what diagnoses should be included in the “psychiatrists’ bible” and how those diagnoses should be determined within the existing framework of the DSM.

Many feminist psychologists, psychiatrists and social workers are calling for stronger actions, including a boycott of the DSM-5 by clinicians, and Congressional hearings to address psychiatric diagnosis and the damaging effects of labeling people deemed to be “mentally ill.”

Foremost among these advocates is feminist psychologist Paula J. Caplan, a fellow in the Women and Public Policy Program at Harvard’s Kennedy School, and the Joan-of-Arc of the new PLAN T Alliance (Psychiatric Labeling Action Network for Truth). The alliance is a coalition of individuals and organizations formed because of frustration with the unscientific nature of the DSM, the harm done to many people who receive arbitrary diagnostic labels, and the unwillingness of the APA to undertake serious reform.

“It is increasingly clear that the editors of the major psychiatric manual, which reaps huge profits for the APA, are ignoring the massive evidence of harm done by the labels of previous editions of the manual and of likely harm from what they plan to put in the [DSM-5],” says Caplan, who resigned from two prior DSM committees because “they were playing fast and loose with the unscientific research related to diagnosis.”

Critics of the alliance’s call to action believe its attempts at serious reform are what one called a “broadside” against psychiatry. Many support a parallel petition seeking DSM-5 revisions. While one prominent psychiatrist active in the development of previous DSMs acknowledges that there are serious problems with DSM-5, he argues that activist groups are criticizing the DSM-5 to smear all psychiatry in a way that is detrimental to people whom it could help.

But given what’s coming in DSM-5, the manual itself appears to be detrimental, especially for women, children and the elderly. For example, grief after the loss of a loved one could be labeled “depression,” leading to medication if it lasts longer than two months.

“Premenstrual Dysphoric Disorder,” PMS, is slated to return to the DSM, pathologizing many menstruating women. “Binge Eating Disorder,” with alarmingly normal indicators, will be included, as will “Borderline Personality Disorder,” with roughly 75 percent of patients given that label being women, according to Dr. Dana Becker of the Bryn Mawr Graduate School of Social Work.

“Sexual dysfunctions” such as “Female Orgasmic Disorder,” defined as a “persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase” is another concern. The diagnosis is “based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable given her age, sexual experience, and the adequacy of sexual stimulation she receives.” DSM-5 modifications describe further symptoms, an exercise NYU psychologist Dr. Leonore Tiefer calls an attempt at “rearranging deck chairs on the Titanic.”

Feminist psychologists have been challenging DSM diagnoses since the 1980s when the Association for Women in Psychology coordinated a petition regarding DSM-III-R. Today they are joined by others in a groundswell of opposition to the APA’s newest effort.

Al Galves, executive director of the International Society for Ethical Psychology and Psychiatry, is among them. He wants to see DSM-5 jargon replaced with relevant terms reflecting the stresses of modern life—loss, despair, loneliness, hopelessness—words relating to “emotional distress, spiritual emergencies, life crises, and difficult dilemmas.” The question, he says, is “how do you get the psychiatric establishment and the pharmaceutical industry to revamp totally” so that they move away from the language of the medical model and use ordinary words to facilitate helping people who are suffering.

Dr. David Elkins, professor emeritus of Psychology at Pepperdine University, agrees it’s time to frame harm done by the DSM as a “social justice issue,” although he stops short of endorsing the PLAN T Alliance call for a boycott just yet. In a letter to the DSM-5 Task Force and the APA on behalf of the division for Humanistic Psychology/American Psychological Association, he called for “an external, independent review” to ensure that the DSM-5 is “safe and credible.”

But perhaps Paula J. Caplan put it best in posting a petition at change.org: “This call is not an attack on or a questioning of psychotherapy or even diagnosis across the board but simply an attempt to draw attention to this minimally investigated enterprise of psychiatric diagnosis and to find ways to protect people from the harm that can result.”

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