Why Psychiatrist Should Sign The Petition To Reform DSM-5 - Psychiatricanswers

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The Debate Goes On

Why Psychiatrists Should Sign The Petition To Reform DSM-5

By Allen Frances, MD
November 2011

Comments on the Psychiatry times web as a respond to the article ...
Dr. Frances, you are not alone. I participate in several forums including the World-wide network of Hispanic Psychiatrists and hear similar concerns about the final product of DSM-5. On the other hand, at a personal level, for years I have opposed the American Academy of Child and Adolescent Psychiatry's stance of blaming children for behaviors that are due to a mental illness. In 1995-99 I was viciously coldshouldered by several of my Arizonian colleagues because I was diagnosing children with bipolar, PTSD, Obsessive-Compulsive and other disorders instead of jumping into the ADHD/ODD wagon.

Like me, many others support your fight but they are part of what politicians call the Silent Majority. Furthermore, like a Red Sox fan, many psychiatrists are convinced that nothing will ever change "(we are going to lose)"  and therefore why bother?
From the other corner, "the powerful minority" controls the flow of information "within the Kingdom" and, at in the end, its views will prevail to the detriment of thousands of patients who will be misdiagnosed and consequently mistreated. It should be noted that in 2000, Psychiatric News (one of the official voices of the APA) reported that 60% of psychiatric care in the USA was provided by primary care physicians who are not aware, for example, of the bipolar spectrum concept. They still believe that "bipolar" applies only to an individual who experiences serious depressive and manic episodes. By the same token, I find it hard to believe that internists ask about a family history of mental illness before prescribing antidepressants for fibromyalgia; indeed, some of my patients have returned for follow up appointments in a full state of mania, owing to "therapeutic doses of a pain medication."
If there is any consolation for Dr. Frances and people like me, could find in the middle of this "Chronicle of a Foretold Death," as Gabriel Garcia Marquez would said, perhaps it is that many psychiatrists ignore DSM's guidelines and diagnose to suit their own preferences. Case in point: ADHD in the presence of autism or mental retardation; ODD "when the symptoms can be better explained by the presence of a mood disorder or anxiety disorder," etc. I will never forget a boy in the outskirts of Phoenix, diagnosed with ADHD and oppositional-defiant disorder, because he was "hyperactive" (nervous) in class and later on refused to attend school altogether because of a severe case of Social Anxiety Disorder.
I want to conclude with the words of the famous Spanish poet Leon Felipe who in 1942 wrote: El otro grito es más reciente. Yo también estuve en el coro. Aún tengo la voz parda de la ronquera. Fue el que dimos sobre la colina de Madrid, el año 1936, para prevenir a la majada, para soliviantar a los cabreros, para despertar al mundo: ¡Eh! ¡Que viene el lobo! ¡Que viene el lobo!…. ¡Que viene el lobo!
The poet refers to those that chose to ignore the voices of warning about incoming dangers ("Yo tambien estuve en el coro," I was part of the Chorus too, in reference to the Fascism coming with Hittler, Franco and Mussolini) and points directly to "the good old boys that covered their ears with cement and now ask why are these Spaniards so loud?"

Manuel Mota-Castillo, M.D.

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