Saturday, February 18, 2012


I’ve written here several times about the fifth edition of the psychiatric Diagnostic & Statistical Manual of Mental Disorders (“DSM-5”), to be published next year. Outraged criticisms of its proposed changes seem to fly at it daily. There’s a decent online review of some at ( The author, Allen Frances, MD, is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. I suppose he knows something of the subject, as he was Chair of the DSM-4 Task Force, editors of the current edition.

The most common criticism is that DSM-5 will radically expand the boundaries of psychiatry, medicalizing normality and thus leading to unneeded and harmful treatment. For example, adults who exhibit only three symptoms instead of the current six could be diagnosed with Attention Deficit Disorder. And much of normal grieving will be considered a psychiatric disorder.

Over the past forty years, psychiatry has drifted increasingly from psychotherapy to psychopharmacy. The manufacturers of psychiatric drugs would love to see increments of normal behavior get labeled abnormal. “You’re not just anxious, you have a chemical imbalance, and we at Avarice Pharmaceuticals have just the thing for you, SerenetinTM. Ask your doctor.”

One wonders, then, whether the twenty-nine DSM-5 authors might have come under the sway of drug pushers. I suggest you check for yourself. There’s a list of them along with any industry connections at I explored the first eleven on the list and stopped there, as I have a life to live, too. Of those eleven, nine list various associations with pharmaceutical companies, as consultant, stockholder, or grant or honorarium recipient.

Forty years ago, these associations would have been considered unethical. In fact, some universities are now banning them. Far be it from me to disagree with Mitt Romney, but I just don’t believe corporations are people. Unlike human beings, they don’t give up or retire or die. They’re unrelenting. Avarice Pharmaceutical's foot is not only in the medical door, but its reps have been lounging around the living room for decades now. We’re so used to their presence that we put up with their conniving and greed, and seem no longer able to show them the door.

For those of us who like to get drugged so we can pretend that everything in our life is okay, this system works. The rest of us, though, would do well not to inform our psychiatrist that we’re grieving. 


  1. This is good stuff you wrote, Jeff.

    60 Minutes tonight had a very interesting piece on the placebo effect and anti-depressants. In most cases it was claimed that the effect is virtually all placebo. They also said that drug companies may only publish the studies that support their drugs and bury as many as 80% that don't.

  2. When I was in medical school my attending for psychiatry was definitely burned out. Yet, I could still see what he had been and always respected him for that. It's a tough field, perhaps that's why I chose an area like surgery where success comes with the territory more frequently.

    I have also been saddened by the "burning out" of medicine as I used to know it.