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Important: New Scientist article disputes scientific credibility of DSM

These two very recent New Scientist articles further below are being brought to your attention in order to press home to you all that seeking to get PAS established in the DSM is in a sense a red herring and could badly misfire, if conditions such as "premenstrual dysphoric disorder" are seriously being considered for inclusion (will hysteria be re-included, accordingly? ;-).

The scientific credibility of the classification system seems to be in the process of being severely undermined.

Practicants who find these approaches diagnostically useful need to be aware that the underlying science needs to be understood and explained in other more intellectually satisfying ways.

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It could misfire in the sense that just as you seek to get PAS included, the whole ship goes down in flames. At a more insidiously destructive level, if such doubts are being expressed by scientists themselves, then what likelihood have the British or other courts of accepting or maintaining legal recognition of a psychological appraisal based on a questionable disorder? Far better to use the existent strong body of evidence in favour of respecting children's identities fully, as the sons and daughters of two parents who are recognised and supported equally by the law in their parental duties and pleasures.

I sometimes think there is more psychological insight in human rights laws which call on us all to respect essential human dignities, to one own identity, culture, the right to one's own language and one's own parents, than there ever has been in the psychiatry applied to a lot of socially generated mental health issues. This may be because psychology as a whole is too internalised, too intent on the internal workings of the human mind rather than what passes between us. The plethora of syndromes scarcely disguises this fact, it simply makes the science look more medieval as it struggles to come up with a satisfactory containing theoretical matrix.

The second article considers "corporate-sponsored disease" through the lens of unhealthily venal liaison between drugs companies and psychiatrists, but the same could equally apply to any interest group which uses falsely defined science because it serves its specific interests.

Let me try to show what I mean. At present, PAS is diagnosed according to the severity of its symptoms. But this leaves the problem of many thousands of families where, perhaps precisely to avoid the encapsulating of such symptoms in a form which finds pathological expression, millions of parents (and children) each year are deterred from recontacting each other, for fear of disturbing the status quo, a position deepened with each successive year in each other's absence. This category of people could be described as having developed "professional aversion syndrome" and one has to ask why?

What are we to do, include this as yet another disorder in the DSMV? Throughout most of the Western world, the same norms as regards psychological diagnosis do not necessarily apply as they do in the United States, so a strategy of appealing for recognition of PAS as a DSMV disorder is even less appropriate.

Part of the value of international discussion between parents' groups is that such policy issues can be debated and quite possibly resolved. I hope this can be translated into other languages. You have below the legitimate concerns and severe misgivings about DSMV, after considered reflection and consultation, of the editorial team at New Scientist. This is credible enough to warrant discussion. A reframing of the absolute cruelty of sole custody presumptions, and their obvious ill effects on the families concerned, both in terms of personal happiness and a general adoption of alienation psychology as a mode of social interaction, perhaps? Most things start in the family.

Julian Fitzgerald Leeds - UK


Do drug firm links sway psychiatry?
29 April 2006
Peter Aldhous

A DISTURBING number of the experts who help write psychiatry's most influential diagnostic manual have financial ties to drug companies, raising concerns about the independence of diagnostic advice in the manual.

While such possible conflicts of interest are not uncommon, psychiatry is of particular concern because diagnosis is so tricky. Physicians rely heavily on the Diagnostic and Statistical Manual of Mental Disorders, or DSM, which categorises psychiatric illnesses and their diagnostic criteria. "The existence of disease categories validates the need for drugs," says Mildred Cho, a bioethicist at Stanford University in California. "Companies have an incentive to influence those creating the categories."

Lisa Cosgrove, a clinical psychologist at the University of Massachusetts in Boston, began to worry about such conflicts when she discovered that a majority of the members of a panel formed to consider whether to include "premenstrual dysphoric disorder" in the manual had received money from Eli Lilly. In 2000, Lilly won approval from the US Food and Drug Administration to market Prozac, rebranded as Sarafem, to treat the condition.

Together with Sheldon Krimsky of Tufts University in Medford, Massachusetts, Cosgrove looked at whether members of other DSM panels had financial ties to drug firms. Such ties included receipt of funding for research, acting as a consultant and being paid for speaking. Overall, 56 per cent of panel members had such links, and all members of the panels for "schizophrenia and other psychotic disorders" and "mood disorders" had such links (Psychotherapy and Psychosomatics, vol 75, p 154). Drugs are used in both areas, and in the case of mood disorders drug companies have been accused of "disease mongering" (New Scientist, 15 April, p 38).

“All the panel members collected to write the diagnostic manual on mood disorders had financial ties to drug firms” Even subtle changes to the DSM can have a big effect on patterns of prescribing. This is a worry for conditions such as attention deficit hyperactivity disorder (ADHD). "There has been a gradual broadening of the diagnostic criteria," says James Swanson of the University of California, Irvine. Cosgrove and Krimsky found that 62 per cent of the DSM panel dealing with disorders such as ADHD had links to drug firms.

The American Psychiatric Association (APA), which publishes the DSM, says its experts are not influenced by their financial ties. However, those recruited for the next edition, to appear in 2011, will be required to declare such interests. "This information will appear in the publication," says the APA's Darrel Regier.

Krimsky argues that the APA should ensure that no DSM panel has a majority of members with ties to drug companies. "It is time that the profession of psychiatry takes a serious look at itself from an ethical standpoint," he says.

From issue 2549 of New Scientist magazine, 29 April 2006, page 14