Let me start out by saying that I have a low opinion of the Huffington Post largely because of its rhetorical approach to psychiatry. Tales about the pharmaceutical company corruption of psychiatry, ongoing articles about the myth of mental illness, references to very poorly done research that supposedly discredits psychiatry, the idea that the DSM is either a manual for everyman instead of clinical psychiatrists or a book written to manipulate the general public - the Huffington Post has it all and then some. Interestingly, the Huffington Post lists these postings under "Science" when it is clear that nobody there seems to know the first thing about science or how it differs from personal opinion. From what I have seen, listing yourself as an authority on science apparently makes it so on the Internet. "Rhetoric/Politics" would be a much more accurate heading.
Enter Allen Frances commenting in blog form. I have already responded to one of the Dr. Frances editorials that seem to pop up everywhere. I find the whole process of taking a scientific debate within a professional society into a public forum somewhat appalling. In this case, the rhetorical device of applying a decision made about an entirely different process - withdrawing a paper that the author believes was incorrectly done due to a methodological error ( one that is common to much psychosocial research) to the DSM process seems rhetorical to me. That occurs after the process has been thoroughly politicized in the media.
The arguments themselves are either red herring or they make it seem like the very public decrying of the DSM process has shamed the APA into not declaring grief and psychosis risk to be diagnoses. The public will never know what the APA process would have decided on these issues and of course every critic wants to take credit for exposing the APA as a group of money grubbing scoundrels whose only mission in life is to appease Big Pharma or generate huge revenue for the organization.
I wish I could count on the public to be as skeptical of these opinions as they are of other political opinions. Unfortunately after 25 years of practice, I can say with certainty that only a few people know what a psychiatrist is or how they are trained. Today there is more misinformation than ever about psychiatry via the Internet.
As a reminder, the DSM is for clinical psychiatrists and psychiatric research. Reading criteria without the associated training is not the same thing as making a diagnosis. There are many nonpsychiatric mental health professionals and many nonpsychiatric physicians. In fact, the bulk of psychotropic medications in this country are prescribed by nonpsychiatric physicians. Access to psychiatrists is tightly controlled by managed care companies and state governments. It is difficult to see a psychiatrist initially and over time. These same managed care organizations control who is admitted to and discharged from inpatient psychiatric units and the type of care provided there.
The idea that the APA is an omnipotent organization with the power to manipulate and control the provision of mental health care through out the USA is a myth of massive proportions. The idea that the DSM is a potential tool for that manipulation is another.
You can probably read about that first on the Huffington Post.
George Dawson, MD, DFAPA
I find the Huffington Post to be terrible all around. Their articles make me want to claw my eyes out.
ReplyDeleteI think people don't realize that clinicians need diagnoses in order to get paid, and it has jack to do with being in cahoots with Big Pharma. Money buys cool things like food and clothing. A lot of clinicians don't honestly make a lot of money (non-psychiatric therapists and case workers). Those who do make what many would consider a large sum of money (doctors, psych nurse practitioners, and psych physician assistants) have to be able to discern the "physical" versus the "mental" - and whether or not the "mental" is "neurological" versus "psychiatric." And the lines blur frequently. Psychiatrists do not have easy jobs, and they're often abused by hospitals and government agencies. I found out after my first psychiatrist had skipped the country that he was seeing over thirty people in a nine hour day. His reputation was excellent - I never heard a bad thing about him from area therapists and case managers - and he always remembered the little nuances of my life. I'm not sure if he took good notes or I was that much of a pain in the ass that it was easy for him to remember me. I'm rather happy I sent him a thank you card before he left (this was prior to learning about his caseload).
I sometimes think that the objections people have to psych issues lay in antiquated notions on mind/body dualism. Mind and body are not separate, and frankly there isn't any reason to believe they are. Religions don't generally equate the brain with the soul.