Shrink, critics face off over psychiatric manual

CEBU, Philippines - In the new psychiatric manual of mental disorders, grief soon after a loved one’s death can be considered major depression. Extreme childhood temper tantrums get a fancy name. And certain “senior moments” are called “mild neurocognitive disorder.”

Those changes are just some of the reasons prominent critics say the American Psychiatric Association is out of control, turning common human problems into mental illnesses in a trend they say will just make the “pop-a-pill” culture worse.

Says a former leader of the group: “Normal needs to be saved from powerful forces trying to convince us that we are all sick.”

At issue is the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, widely known as the DSM-5. The DSM has long been considered the authoritative source for diagnosing mental problems.

The psychiatric association formally introduces the nearly 1,000-page revised version this weekend in San Francisco. It’s the manual’s first major update in nearly 20 years, and a backlash has taken shape in recent weeks:

•Two new books by mental health experts, “Saving Normal” and “The Book of Woe,” say the world’s most widely used psychiatric guide has lost credibility.

• A British psychologists’ group is criticizing the DSM-5, calling for a “paradigm shift” away from viewing mental problems as a disease. An organization of German therapists also attacked the new guide.

•Even the head of the U.S. National Institute of Mental Health complained that the book lacks scientific validity.

This week, the NIMH director, Dr. Thomas Insel, tried to patch things up as he and the psychiatrists group issued a joint statement saying they have similar goals for improving the diagnosis and treatment of mental illness.

The manual’s release comes at a time of increased scrutiny of health care costs and concern about drug company influence over doctors. Critics point to a landscape in which TV ads describe symptoms for mental disorders and promote certain drugs to treat them.

“Way too much treatment is given to the normal ‘worried well’ who are harmed by it; far too little help is available for those who are really ill and desperately need it,” Dr. Allen Frances writes in “Saving Normal.” He is a retired Duke University professor who headed the psychiatry group’s task force that worked on the previous handbook.

He says the new version adds new diagnoses “that would turn everyday anxiety, eccentricity, forgetting and bad eating habits into mental disorders.”

Previous revisions were also loudly criticized, but the latest one comes at a time of soaring diagnoses of illnesses listed in the manual - including autism, attention deficit disorder and bipolar disorder - and billions of dollars spent each year on psychiatric drugs.

The group’s 34,000 members are psychiatrists - medical doctors who specialize in treating mental illness. Unlike psychologists and other therapists without medical degrees, they can prescribe medication. While there has long been rivalry between the two groups, the DSM-5 revisions have stoked the tensions.

The most contentious changes include:

•Diagnosing as major depression the extreme sadness, weight loss, fatigue and trouble sleeping some people experience after a loved one’s death. Major depression is typically treated with antidepressants.

•Calling frequent, extreme temper tantrums “disruptive mood dysregulation disorder,” a new diagnosis. The psychiatric association says the label is meant to apply to youngsters who in the past might have been misdiagnosed as having bipolar disorder. Critics say it turns normal tantrums into mental illness.

•Diagnosing mental decline that goes a bit beyond normal aging as “mild neurocognitive disorder.” Affected people may find it takes more effort to pay bills or manage their medications. Critics of the term say it will stigmatize “senior moments.”

•Calling excessive thoughts or feelings about pain or other discomfort “somatic symptom disorder,” something that could affect the healthy as well as cancer patients. Critics say the term turns normal reactions to a disease into mental illness.

•Adding binge eating as a new category for overeating that occurs at least once a week for at least three months. It could apply to people who sometimes gulp down a pint of ice cream when they’re alone and then feel guilty about it.

• Removing Asperger’s syndrome as a separate diagnosis and putting it under the umbrella term “autism spectrum disorder.”

Dr. David Kupfer, chairman of the task force that oversaw the DSM-5, said the changes are based on solid research and will help make sure people get accurate diagnoses and treatment.

Dr. Jeffrey Lieberman, the psychiatry association’s incoming president, said challenging the handbook’s credibility “is completely unwarranted.” The book establishes diagnoses “so patients can receive the best care,” he said, adding that it takes into account the most up-to-date scientific knowledge.  (FREEMAN)