Monday 13 February 2012

New mental health guide 'dangerous'

International manual treats normal behaviour as illness, say some experts
The Straits Times, 11 Feb 2012

LONDON: Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labelled as mentally ill by a new international diagnostic manual, said specialists at a meeting in London.

In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the manual were at best 'silly' and at worst 'worrying and dangerous'.

'Many people who are shy or bereaved... will suddenly find themselves labelled as mentally ill,' said Professor Peter Kinderman, head of Liverpool University's Institute of Psychology, at the briefing on widespread concerns over the manual.

'It's not humane, it's not scientific, and it won't help decide what help a person needs.'

The DSM is published by the American Psychiatric Association (APA) and lists definitions and diagnostic criteria for all mental disorders.

More than 11,000 health professionals have already signed an online petition calling for the development of the fifth edition of the DSM to be stopped and re-thought.

Experts said some diagnoses - for conditions like 'oppositional defiant disorder' and 'apathy syndrome' - risk medicalising behaviour which most people would consider normal or just mildly eccentric.

At the other end of the spectrum, the new DSM could give medical diagnoses for serial rapists and sex abusers - under labels like 'paraphilic coercive disorder' - and may allow offenders to escape prison by providing an excuse for their behaviour, the experts said.

Dr Simon Wessely of the Institute of Psychiatry at King's College said a look back at history should make health experts ask themselves: 'Do we need all these labels?'

He explained that the 1840 Census of the United States included just one category for mental disorder but by 1917, the APA was already recognising 59. That rose to 128 in 1959, to 227 in 1980, and to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.

Dr Allen Frances, chairman of the committee that oversaw the previous DSM revisions, said the fifth edition would 'radically and recklessly expand the boundaries of psychiatry' and result in the 'medicalisation of normality, individual difference, and criminality'.

Dr Nick Craddock of Cardiff University cited depression as a key example of where DSM's broad categories were going wrong.

He said that in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement. But the new criteria would ignore the bereavement, look only at the symptoms and class the person as having a depressive illness.

Another example cited was 'oppositional defiant disorder' - a condition in which a child 'actively refuses to comply with majority's requests' and 'performs deliberate actions to annoy others'.

'That basically means children who say 'no' to their parents more than a certain number of times. On that criteria, many of us would have to say our children are mentally ill,' said Prof Kinderman.

In Singapore, the Ministry of Health said that while the DSM was a widely used manual, psychiatrists did not rely on it alone.

'Practitioners generally do not just adhere to the DSM criteria in making a diagnosis,' a ministry spokesman said in response to queries by The Straits Times.

'Any diagnosis for mental illness needs to take into account the peculiarities of each case and the social and cultural context of the patient.

'Individual clinicians need to exercise their own judgment before making a diagnosis of mental disorder, as mental illnesses are inherently complex.'

Associate Professor Daniel Fung, chairman of the medical board at the Institute of Mental Health, agreed. He said that the DSM was a useful classification system for facilitating communication among experts on mental health illnesses but it should not be the only tool in clinical diagnosis.

Dr Thomas Lee, a psychiatrist in private practice, did not think there was a great risk of healthy people being wrongly diagnosed as mentally ill.

'Although the DSM serves as a diagnostic guide, in our clinical assessments, we also rely on other tools such as our clinical experience, research and discretion,' he said.

Meanwhile, the revision of the DSM is still at the consultative stage; the manual is targeted to be out next year. The review so far has included a tightening of the definition of autism that would sharply reduce the skyrocketing rate at which the disorder is diagnosed.


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