Doctor Allen Frances, M.D., was chair of the DSM-IV Task Force that
published the well known Manual in 1994; He was also chair of the department of
psychiatry at Duke University School of Medicine, Durham, NC and is currently
professor emeritus at Duke. While working at the DSM, he established strict
guidelines to ensure that changes from DSM‐III‐R to DSM‐IV would be few and well supported
by empirical data. Recently, Dr. Frances objected the new Diagnostic Criteria
and predicted potentially grave problems in the DSM‐V goals, methods, and
products due to the intervention of the Pharmaceutical companies in the
edition and selection of those criterias; he stated that “unless its course is corrected, DSM‐V will
lead to many damaging unintended consequences”.
Here is the editorial published by Psychiatric Times where Dr Frances
reveals the tensions within the members of the DSM V task force and the
intervention of the Pharmaceutical Companies.
El Doctor Allen
Frances perteneció a la fuerza de trabajo que desarrollo el DSM IV y que publico
su famoso manual en 1994. El fue también miembro del departamento de psiquiatría
de la universidad de Duke en Carolina del Norte, donde hoy trabaja como
profesor emérito. Mientras trabajaba en el DSM, el estableció unos estrictos parámetros
para asegurar que los cambios entre el DSM-III-R y el DSM IV fueran pocos y
bien soportados por datos empíricos. El Dr. Frances, recientemente, objetó los
nuevos criterios diagnósticos y predijo potenciales graves problemas en las
metas, métodos y productos del DSM V, gracias a la intervención de las compañías
farmacéuticas en la redacción y selección de dichos criterios. El ha dicho que “A
menos que el curso sea corregido, el DSM V llevara a muchas, aunque involuntarias,
consecuencias nefastas” (la traducción es mía). Aquí está el editorial publicado por la
revista “Psychiatric Times” en donde el Dr. Frances revela las tensiones entre
los miembros de la fuerza de trabajo para el DSM V y la intervención de las compañías
farmacéuticas.
Mike Rosenthal:
http://vectorbelly.com/electrical45.html
DSM-5: Dissent From Within
By Allen Francis, MD | January 3, 2011
Many people
associated with DSM-5 have privately expressed their serious doubts to me, but
felt muzzled into public silence by constraining confidentiality agreements and
loyalty to the process. Gary Greenberg's recent DSM-5 piece inWired offers a
set of dispirited quotes from discouraged Work Group members--but again he
elicited them only under the promise of strict anonymity. Until now, the only
people connected to DSM-5 to express public displeasure were the two who have
resigned from it.
John Livesley, a
highly respected member of the Personality Disorders (PD) Work Group, has now
broken this fortress defensiveness and enforced wall of silence. He has
published a brilliantly reasoned critique titled "Confusion and
Incoherence in the Classification of Personality Disorder: Commentary on the
Preliminary Proposals for DSM-5."
The title says it
all --the PD proposal is a pretentious emperor without any clothes. Livesley
systematically catalogs all its many defects: breathtakingly radical change
based on questionable empirical support, lack of reasonable rationale, mind
boggling and incoherent complexity, poor taxonomic methods, and inconsistency
among components. This is a proposal that will never be used by clinicians,
will greatly hamper personality disorder research, and will blacken the
reputation of dimensional diagnosis. It will reduce the credibility of
personality disorder as an important clinical issue, leading patients with
severe personality problems to be misdiagnosed and hence mistreated or not
treated at all.
Opposition to the
proposal is virtually unanimous among personality disorder experts. Strong
critiques have been, or soon will be, published in The American Journal of
Psychiatry; the Journal of Abnormal Psychology; the Journal of Personality
Disorders; and Personality Disorders: Theory, Research, and Treatment. Only a
very flawed and unnecessarily closed DSM-5 process could have allowed the
survival to this late stage of such bizarrely misguided and idiosyncratic
suggestions.
Clearly, breaking
with his colleagues was not an easy step for Dr Livesley, or one he took
lightly. The confidentiality restrictions turned out not to be a problem-- he
bypassed them simply by using only information that is already available in the
public domain. His more difficult choice was whether to expose the follies of
the PD work group-- given his understandable bond of loyalty to colleagues on the
committee. Fortunately, this was trumped by four much stronger and even more
admirable loyalties-- "to intellectual honesty, respect for empirical
findings, and concern for the future of the field and patient care."
I know that many
other DSM-5 workers are similarly disturbed by the lack of organization in the
DSM-5 process and the wayward nature of many of its proposals. They have
heretofore been frozen into immobile public silence by some combination of team
spirit, passivity, the confidentiality agreements, distaste for controversy,
and fear of retaliation. Dr Livesley's well reasoned dissenting opinion
provides DSM-5 participants with a model of responsible behavior under
difficult circumstances. Principled and
open dissent is a time-honored way of reconciling the conflicting pressures
they must feel. If this is a good enough approach for the Supreme Court, why
not have it inform a DSM-5 process that has become the supreme court of
diagnostic judgment?
Everyone involved
with DSM-5 should follow Dr Livesley's example and at last feel encouraged to
speak openly. They needn't worry about
confidentiality agreements if comments focus on information that is posted and
public. Intellectual honesty and concern for patient welfare trump narrow
loyalties to colleagues or guild interest.
It is not too
late to save DSM-5 from itself-- if only those working on it will finally break
free of groupspeak and share their thoughts with the field-- as they should
have been encouraged to do from very outset. The current sad state of DSM-5 has
been caused by secrecy and defensiveness. The only salvation is completely
frank and open discussion. Great thanks are owed to Dr Livesley for having
demonstrated the wisdom, responsibility, and courage to light this path for his
colleagues.
Dr Livesley's
article can be found online in the current issue of the journal Psychological
Injury and the Law
-http://www.springerlink.com/openurl.asp?genre=article&id=doi:10.1007/s12207-010-9094-8.
I recommend it highly to anyone interested in the conceptual issues that
underlie personality disorder diagnosis and more broadly to those concerned
with the problems that have bedeviled the development of DSM-5. He will be
publishing additional thoughts in a spring issue of the Journal of Personality Disorders
devoted to the DSM-5 suggestions.
