The "Bible of Psychiatry" Faces Damning Criticism—From the Inside

By Sophie Bushwick | July 13, 2012 8:30 am

psychiatrist and patient

The Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, governs the tricky science of psychiatric diagnosis. But this gold standard of diagnosis is anything but infallible: as knowledge of mental disorders grows, successive editions have had to change their definitions. The fifth version, due to be published next year, is already drawing criticism—and the most recent attack comes from within the DSM-5’s ranks.

Roel Verheul and John Livesley, a psychologist and psychiatrist who were members of the DSM-5 work group for for personality disorders, found that the group ignored their warnings about its methods and recommendations. In protest, they resigned, explaining why in an email to Psychology Today. Their disapproval stems from two primary problems with the proposed classification system: its confusing complexity, and its refusal to incorporate scientific evidence.

The proposal displays a truly stunning disregard for evidence. Important aspects of the proposal lack any reasonable evidential support of reliability and validity. For example, there is little evidence to justify which disorders to retain and which to eliminate. Even more concerning is the fact that a major component of proposal is inconsistent with extensive evidence…This creates the untenable situation of the Work Group advancing a taxonomic model that it has acknowledged in a published article to be inconsistent with the evidence.

An inaccurate DSM-5 could lead to misdiagnosed patients receiving useless or even harmful treatments. But even as criticism of their proposed changes pile up, “the Work Group seems impervious.” For more details of the researchers’ problems with the DSM-5, read their full message.

Psychiatrist-and-patient image via Shutterstock

CATEGORIZED UNDER: Mind & Brain
  • Hemo_jr

    Psychiatry is a pseudo-scientific discipline that has continually rejected scientific methods over the years. In fact, calling it a discipline is a misnomer embedded with irony.

    There were hopes that it would reform itself. But this is evidence it has not.

  • Wall-E

    Hemo_jr is right.

  • scribbler

    (Flipping through pages) You are both crazy!

    (flipping through more) Damn! So am I!

    ;-)

  • Hominid

    Psychiatry is clinical medicine; clinical medicine is technology, not science.

    The DSM has always been an amalgam of opinions having more to do with pop culture and politics than with scientific evidence.

  • Martin Forde

    Hemo_jr isn’t right at all. He’s taking a very specific aspect of Fruedian psychoanalysis and generalizing to the entire field of psychiatry. It’s moronic. Yes, the personality disorders are a mess, primarily because they find their basis in Fruedian archetypes. However, that doesn’t negate the entire field as unscientific. In fact, if you look at any recent (i.e., within the last 50 years) research, you will realize that it is entirely dependent upon hypothesis testing and statistical inference. If you think that’s not science, then you’re certainly not a scientist.

  • Martin Forde

    Hence, the reason these scientists resigned from the DSM-V workgroup is because APA is deciding to keep the most idiotic aspects of the DSM-IV which aren’t backed by research.

  • willys36

    “The proposal displays a truly stunning disregard for evidence.” That pretty well sums up everything the government does to us.

    Remember, it’s all George Bush’s fault.

  • Kaviani

    @ Martin Forde: peppered with cherry picked data, primed subjects, etc.

    http://www.nature.com/news/the-data-detective-1.10937

  • Martin Forde

    @Kaviani

    “I doubt that fabrication is any worse in psychology than in other fields.”

    and?

  • Phil S.

    The very concept that a questionnaire can be used as the primary tool in diagnosis is a total joke and always has been. The human body is simply too complex for such a method to work reliably. The number one component that allows any of the beliefs in this field to go anywhere, is human ignorance. This profession preys upon that ignorance with frightening regularity. A major component in psychiatry that allows it to even operate, is the placebo effect. In other words, this profession is mostly fraud. These people are all responsible for scams that are meant to confuse and deceive through complexity and technicality that looks similar to the derivative scam that took place on wall street. To date there are no medical tests, no method or means to correct or even really understand patients’ illnesses. There is no reliable means to even know what medications are doing to correct any real problem. Many of these medications are now being used on the streets as narcotics because of how similar there reactions are to narcotic type drugs. The mental health system looks like the work of men and women who suffer from mental disturbances.

  • Phil S.

    Serotonin and other chemicals present in the brain and body are being studied by other fields. Psychiatry does nothing to inform or teach it’s members about how any of this chemistry they work with comes into being in the first place or that the precursors for these compounds can be tested for. Nothing is taught what so ever about how any of these processes can go wrong or why. They also do not study what physical health looks like or what mental health looks like. Both are key elements in understanding an illness.

  • Phil S.

    Most disturbing of all is how unaware the average person is as to the number and level of harm being perpetrated by this profession. Many medications cause the very illnesses they claim to treat and because of the level of mystique and mysticism surrounding the medical side of what psychiatry claims to treat, it is nearly impossible to prove or untangle. It is very easy to provide a treatment that causes the very illness it claims to treat and then convince consumers that they had that illness all along.

  • Phil S.

    If psychiatry was required to take the Hippocratic oath to heart their profession would likely end. This field gets by with everything they do because of the few they may “accidentally” help, which they hide behind like a shield. If focus were to be shifted from those helped to the vast amount of harm being done it would likely lead to real answers and put an end to the current farce that is perpetuating itself.

  • http://sarkisfamilypsychiatry.com/blog/ Eric Dutton

    “Psychiatry is a pseudo-scientific discipline that has continually rejected scientific methods over the years. ”
    You’ll notice that the ones who are raising the fuss in this story are a psychologist and a psychiatrist. Psychiatry is not a pseudoscience. If it were, there WOULDN’T be so much disagreement among those who practice it.

  • http://facebook adrian serb

    Indeed,psychiatry is not science,is also not medicine and not even something inbetween. They give a diagnostic based on “observation” (during the first 45 minutes initial visit) and on the patient’s sympthoms description. There is no blood work (at least thyroid,sugar,blood culture for infections and Candida,heavy metals…).There is no urine test except,maybe,for drugs.They just love to play the guessing game and to medicate.Anybody can have a break-down and seek help in a psychiatrist office or an ER. Once tthat person takes the “attack dose” of psychotropics,they will have a brain hormonal imbalance and will need to be medicated for the rest of their life.They insist that everything is caused by some imbalance in the brain,no tests available but also no effort to go to the roots of the sympthoms. The psychiatrists are ignoring any “harmless” try,like vitamins,utrition,chelation…Why not study,try and incorporate the complementary medicine? It is too cheap,maybe?

  • Phil S.

    The real underlying reason why psychiatry can not provide useable clinical evidence to back up their claims is because so many of those claims are distortions of what is actually real. There will never be medical tests of any kind as there is rarely if ever real balancing of chemistry or correcting of real medical needs. This is also evidenced by the fact that this profession does so poorly in treating mental illnesses in the first place. This is why so much focus is put upon covering up failures and hiding the harm that is being done as only through such tactics can they continue to practice.

    Modern psychiatry continues to follow down a path that declares the equivalent of narcotics as medical treatments. It all started with cocain elixirs being sold as miracle elixirs. Psychiatry’s claims and methods still today look similar to the deceptive practices of street drug dealers selling wares that will magically cure all ills. When looked upon closely this professions reasoning looks little different then the reasoning of an alcoholic who believes that alcohol will solve and correct his life’s problems and their mantra sounds similar to that of a pot smoker who decries the very idea that their pot is slowly rendering them stupid. All this is hardly a surprise when so much emphasis is put upon anecdotal evidence as the means to determine a treatments success. Patients are set upon from all sides in a desire to convince them that their treatments are successful. It can hardly be a surprise that so many believe the claims set upon them, between therapy and the coaxing of men and women with medical degree’s most people have little chance to really think for themselves. Such abuse of the title doctor should outrage those who work so hard to prove to themselves and patients that their medicine really does solve medical needs. Just how long should it be tolerated that such men and women abuse such an authoritarian role?

  • Phil S.

    One has to wonder if the drug companies goal in backing this profession is to make themselves out to look like a crack dealing operation. With children across the world selling and trading in these so called medicines to get wasted and high at parties, it really can be called a total fiasco.

  • Alex S

    As the husband of someone with PTSD and major depression i will defend psyciatrists (as apposed to psyciatry) as much as i can, for my wife would not be alive without it. Is it Perfect? Hell no; Is is good? maybe not, but what pisses me off is everyone slamming it with no real alternative. We have a very limited understanding of mental conditions and this is what we need to fix, but asking psyciatrists to do this themselves is like asking your local GP to cure cancer, its the wrong target for the person in question. If you had someone walk into your office and be suicidal, you do what you can with what you have available to you and i don’t think you can ask anymore of a clinician. There needs to be more research, more innovative ways to diagnose and treat, but this needs to happen from a research standpoint, not a cinical standpoint.

    In terms of the actual article, good on them, the DSM should be based on evidence with no place for opinion.

  • Geack

    Alex,

    Chances are the people making the most aggressive attacks on psychiatry actually believe they DO have some alternative. The fact that these “alternatives” typically rest on even lesser evidence than psychiatry (or just plain no evidence) seldom serves to temper opinions. As a related side note: Anyone who recommends chelation as a treatment for anything other than acute metal poisoning is either sadly ignorant or a scumbag quack – sometimes they’re both.

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