Bar room brawl over bible of psychiatry

That's how psychiatrist Dan Carlat refers to the process of the revision of psychiatry's Diagnostic and Statistical Manual - or the DSM-V.

Carlat writes about criticism of the process coming from Dr. Allen Frances, the chairman of the committee that created the current DSM-IV. Bullet points of that criticism:

• The process of writing the manual is less transparent and less inclusive than in the past.


• The underlying science of psychiatry has not advanced enough to merit the kind of extreme makeover proposed by the DSM-V chairpeople.


• The main change being proposed--the official inclusion of a series of rating scales into the diagnostic criteria--is poorly conceived because busy clinicians will reject this extra paper-work.


• Other proposed changes in DSM-V will make it too easy to over-diagnose a range of conditions.

Specifically, Frances writes:

"The result would be a wholesale imperial medicalization of normality that will trivialize mental disorder and lead to a deluge of unneeded medication treatment--a bonanza for the pharmaceutical industry but at a huge cost to the new false positive "patients" caught in the excessively wide DSM-V net. They will pay a high price in side effects, dollars, and stigma, not to mentions the unpredictable impact on insurability, disability, and forensics."

Carlat writes that the American Psychiatric Association and DSM leadership responded by accusing Dr. Frances and his colleagues "of being greedy, deceptive, and dumb."

What fun to watch the sausage-making side of science.