Comments on the Psychiatry times web as a respond to the article...
I read Dr. Frances’ formidable essay the day after watching with my daughter “Lord of the Rings, the Return of the King” and I could not help to think of Gandalf (the wise and tough fighter) as a character akin with the unremitting war for the triumph of the truth that Dr. Allen Frances has kept going for years.
Around the same time frame 3 master pieces were published by Psychiatric Time: “Letter to a Young Psychiatrist” by S. Nassir Ghaemi, “Ketamine, Cum Grano Salis” by Ronald Pies and “The Older Psychiatrist in an Era of “Unprecedented Change” by James L. Knoll.
These papers have something in common that I have given me a sense of hope when I thought that it was time to give up my challenge to the loud majority that imposes scientific fallacies just because it can outnumber and overpower dissident voices.
Even though I disagree with Dr. Frances on the issue of medicating children I applaud his stance because we share a more essential issue: diagnostic accuracy. This goes back to the first year in Medical School when we learned that a correct treatment ought to follow a right diagnosis. Like the respected professor, I believe that temper tantrums can be a normal reaction of a frustrated toddler. Unfortunately, I evaluate children that, besides the “mood dysregulation” also act out sexually, hit others without provocation, and would stay up all night if allowed to do so, exhibit adult-like demeanor and several other disturbing behaviors. And then you hear a young and tearful mother that says “please, doctor, tell me that my son is not going to end up been like his father.”
After reading Dr. Frances article on the DSM5 as well as Pies, Ghaemi and Knoll’s philosophical reflections on the practice of medicine I feel empowered to tell the APA (American Psychiatric Association): you missed a historical opportunity to put science behind the psychiatric diagnoses in children… you had the chance of debunking many misconceptions, including that of “ADHD symptoms” but instead you left intact the fallacy that every person with poor attention span that also shows impulsivity and restlessness deserves a diagnosis of ADHD.
We all know that a hypomanic individual struggling with racing thoughts, somebody experiencing the fear of talking in public, another with flashbacks from traumatic events, the one with undiagnosed Absence Seizures, etc., will find difficult to pay attention and hence to retain information.
The APA disappointed those that believe in psychiatric as a solid science that can contribute to better this world. Furthermore, this astronomical failure can provide more ammunition to those fanatics that dream of annihilating our specialty.
Keep the good fight, Dr. Frances.
Manuel Mota-Castillo, M.D.
P.S. I forgot to mention that keeping Oppositional-Defiant Disorder (ODD) and Conduct Disorder (CD) will benefit insurance company that are going to continue using them as excuses to deny hospitalizations. These 2 pseudo-diagnoses were needed in the 80s when the psychoanalytic establishment had a tight control of psychiatry and maintained the belief that children could not get depressed or to have other serious mental illnesses.
These days it is a travesty of science to label as ODD a child with a grandiose/defiant mood or another afflicted by Social Anxiety that refuses to be in a class room…and been around people. Even more harmful is to diagnose CD in a child that “does not improve despite adequate treatment” when the reason for that failure is that his doctor decided that he had co-morbid bipolar and ADHD and is prescribing amphetamine to a patient that shows violent behavior.
As I have said before, in 10 years, that APA and the American Academic of C & A Psychiatry will have to do a lot of explaining.