DSM: ¿la biblia o el malleus mallefiracum

de los profesionales

de ayuda?

Mario A. Núñez Molina

Reflexión

• “Los jueces de la normalidad están presentes en todas partes. Nos encontramos en compañía del profesor-juez, del médico-juez, del trabajador social-juez, todos hacen reinar la universalidad de lo normativo …”(Foucault)

The Malleus Maleficarum (1486)

Las brujas

• Estimados de muerte durante la inquisición: 600,000 to as high as 9,000,000 (over its 250 year long course);

• Casi todas las acusadas eran mujeres.

Kreisman y el DSM

• Jerold Kreisman says, "Well, all psychiatric diagnoses, these days, are defined very clearly in the Diagnostic and Statistical Manual. And, every few years, wise psychiatrists go up to Mount Sinai, talk to God, and define all psychiatric illnesses. If you're a manic-depressive, you have three out of these five or four out of these seven. Borderline Personality Disorder is defined by having five out of the eight criteria." There was, once upon a time, another book from which this kind of scientific certainty was derived. It was the Malleus Maleficarum. The certainty then was about who was a witch.

– 'Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 1529-1532). Kindle Edition.

DSM

Criticas al DSM: Conflict-of-Interest Disorder

http://www.newscientist.com/article/dn21580-many-authors-of-psychiatry-bible-have-industry-ties.html

William Glasser

• “The DSM was not written to help people; it was developed to help psychiatrists – to help them make money.”

Conflicto de intereses

• Al presente, un 69% de los miembros del task force del DSM-5 tienen lazos con la industria farmaceútica.

• Of the 137 DSM-V panel members (that is, workgroup members) who have posted disclosure statements, 77 (56 percent) reported industry ties, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards

– http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001190

Eli Lilly

• Whitaker writes that in the first quarter of 2009 alone, Eli Lilly gave $551,000 to NAMI [National Alliance on Mental Illness] and its local chapters, $465,000 to the National Mental Health Association, $130,000 to CHADD (an ADHD [attention deficit/hyperactivity disorder] patient-advocacy group), and $69,250 to the American Foundation for Suicide Prevention.

– http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/?pagination=false

Conflicto de intereses

• 15 per cent of the work group members were speakers' bureau members.

– http://www.newscientist.com/article/dn21580-many-authors-of-psychiatry-bible-have-industry-ties.html

La transparencia no es suficiente

• However, transparency alone cannot mitigate bias. Because industry relationships can create a “pro-industry habit of thought” , having financial ties to industry such as honoraria, consultation, or grant funding is as pernicious a problem as speaker's bureau participation.

• http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001190

No se habla de los efectos secundarios

• Attention to adverse side effects of medications is virtually nonexistent. Previous editions of the DSM, including the latest text revision published in 2000, glossed over the side effects of psychotropic medications. Only two of more than seven hundred pages of the main body of the DSM-IV-Text Revision deal with diagnosing side effects of psychotropic medication

– http://www.aaup.org/AAUP/pubsres/academe/2010/ND/feat/cosg.htm (Cosgrove)

Efectos secundarios

• A typical patient, he says, might be taking Celexa for depression, Ativan for anxiety, Ambien for insomnia, Provigil for fatigue (a side effect of Celexa), and Viagra for impotence (another side effect of Celexa).

Prejuicios en los procesos de diagnosticar

Clase social y sicopatología

• The "higher" the social class, the less likely an individual was to become a psychiatric patient of any kind; people in Classes IV and V combined were 2 1/2 times as likely as people in Classes I and II to enter psychiatric treatment,

– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 205-206). Kindle Edition.

Mecanismo de control social

• Thus, diagnosis is a mechanism of social control. It could do harm, or it could help, but in either case it is a mechanism of social control.

• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 302-303). Kindle Edition.

Premenstrual dysphoric disorder

"Premenstrual Dysphoric Disorder" (PMDD)

• “PMDD was represented to the public initially by Eli Lilly and later by other pharmaceutical companies as a "distinct medical condition.”

– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 2872-2873). Kindle Edition.

Anuncio de Eli Lilly

• "PMDD affects millions of women.... but the good news is that your doctor can treat PMDD symptoms with a new treatment called Sarafem" (Eli Lilly advertisement 2001).

– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 2891-2892). Kindle Edition.

Sarafem-Prozac

• What women were not told in these ads is that the psychotropic medication produced by Eli Lilly to treat PMDD is Prozac, which had been relabeled as Sarafem and manufactured in pink and lavender capsules.

• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 2892-2894).

Video Sarafem

• http://www.youtube.com/watch?v=2TPtuPt_5Uc&feature=related

FDA

• It is noteworthy that, in December 2000, the FDA sent a warning letter to Eli Lilly, mandating that Lilly cease using this ad for the following reasons: “The imagery and audio presentation of the advertisement never completely define or accurately illustrate premenstrual dysphoric disorder (PMDD) and there is no clear distinction between premenstrual syndrome (PMS) and PMDD communicated. . . . The advertisement is lacking fair balance because the graphics accompanying the audio presentation of the risk information are very distracting and minimize the important risk information.” (Emphasis added.)

– http://www.aaup.org/AAUP/pubsres/academe/2010/ND/feat/cosg.htm

Beneficios para la industria

• It was reported that in the first six months after the FDA approved fluoxetine hydrochloride to treat the unproven entity called Premenstrual Dysphoric Disorder (PMDD), 2.5 million prescriptions for the drug were written.

• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle Locations 3200-3201). Kindle Edition.

Tratamiento natural

• eating smaller, more frequent meals to limit blood-sugar fluctuations;

• cutting back on white flour and sugar intake (which cause blood sugar levels to spike);

• and exercising regularly. Even a brisk 20- to 30-minute walk three times a week, increases mood-boosting serotonin levels, and helps with fluid retention and food cravings. Nutritional supplements like calcium, [B.sub.6] and magnesium also may help.

• http://findarticles.com/p/articles/mi_m0846/is_9_21/ai_84599102/

Medicalización de la normalidad

Major depressive disorder

• DSM 5 would encourage the diagnosis of 'Major Depressive Disorder' almost immediately after the loss of a loved one—having just 2 weeks of sadness and loss of interest along with reduced appetite, sleep, and energy would earn the MDD label (and all too often an unnecessary and potentially harmful pill treatment).

La pena como depresión mayor

• For example, take the case of a man whose spouse unexpectedly dies. For two weeks after the death, he feels sad, doesn't want to go to work, loses his appetite, has trouble sleeping and concentrating. Currently, this is normal grief. The DSM 5 suggestion would have this be major depression.

Epidemias creadas artificialmente

• Ten percent of ten-year-old boys now take daily stimulants for ADHD—”attention deficit/hyperactivity disorder”—and 500,000 children take antipsychotic drugs. (se ha triplicado el número en los últimos quince años)

Attention deficit/hyperactivity disorder

• Attention Deficit/Hyperactivity Disorder. There are 4 suggestions for DSM5 that would make this existing overdiagnosis much worse.– •The first change is to raise the required age of

onset from 7 to 12.•The second is to allow the diagnosis based only on the presence of symptoms, not requiring impairment. •The third is to reduce by half the number of symptoms required for adults.

• We don't have more attention deficit than ever before-we just label more attentional problems as mental disorder. (Allen Frances)

Otros nuevos desordenes problemáticos

MND

MNC

• Minor Neurocognitive Disorder is defined by nonspecific symptoms of reduced cognitive performance that are very common (perhaps almost ubiquitous) in people over fifty.

Binge eating disorder

Disruptive mood dysregulation disorder

Disruptive mood dysregulation disorder

• Disruptive mood dysregulation disorder is one of the most dangerous and poorly conceived suggestions for DSM5―a misguided medicalization of temper outbursts. The “diagnosis” would be very common at every age in the general population and would promote a large expansion in the use of antipsychotic medications.

Paraphilic coercive disorder

• Paraphilic Coercive Disorder would expand the pool of sex offenders who are eligible for indefinite civil commitment because they have a “mental disorder” to include cases of sexual coercion.

Internet use disorder

• Diagnosis of "mental illness" is more an art than a science. DSM-based research has repeatedly shown very poor reliability and, therefore, questionable validity. In a 2005 interview, Robert Spitzer, the architect of the DSM, confessed candidly: "To say that we've solved the reliability problem is just not true. . . It's been improved. But if you're in a situation with a general clinician it's certainly not very good" (Spiegel, 2005, p. 63)

Patologización de la normalidad

• DSM5 would create tens of millions of newly misidentified false positive “patients,” thus greatly exacerbating the problems caused already by an overly inclusive DSM4.7 There would be massive overtreatment with medications that are unnecessary, expensive, and often quite harmful. DSM5 appears to be promoting what we have most feared--the inclusion of many normal variants under the rubric of mental illness, with the result that the core concept of "mental disorder" is greatly undermined. (Frances)

Occupy American Psychiatric Association

Referencias• A MOMENT OF CRISIS IN THE HISTORY OF AMERICAN PSYCHIATRY.

(n.d.).h-madness. Retrieved from http://historypsychiatry.com/2010/04/27/a-moment-of-crisis-in-the-history-of-american-psychiatry/

• Angell, M. (2004). The Truth About the Drug Companies: How They Deceive Us and What to Do About It (1st ed.). Random House.

• Caplan, P. J., & Cosgrove, L. (Eds.). (2004). Bias in Psychiatric Diagnosis. Jason Aronson, Inc.

• Carlat, D. (2010). Unhinged: The Trouble with Psychiatry - A Doctor’s Revelations about a Profession in Crisis (1st ed.). Free Press.

• Cosgrove, L., & Krimsky, S. (2012). A Comparison of DSM-IV and DSM-5 Panel Members’ Financial Associations with Industry: A Pernicious Problem Persists. PLoS Med, 9(3), e1001190. doi:10.1371/journal.pmed.1001190

• Horwitz, A. V. (2003). Creating Mental Illness (1st ed.). University Of Chicago Press.

• Kutchins, H. (1997). Making Us Crazy. Free Press.• Opening Pandora’s Box: The 19 Worst Suggestions For DSM5 -

Psychiatric Times. (n.d.). Retrieved May 2, 2012, from http://www.psychiatrictimes.com/print/article/10168/1522341

• Watters, E. (2010). Crazy Like Us: The Globalization of the American Psyche. Free Press.

• Whitaker, R. (2010). Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill (Second ed.). Basic Books.

• Whitaker, R. (2011). Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (1st ed.). Broadway.

Referencias

• http://www.dsm5.org/Pages/Default.aspx • http://www.ipetitions.com/petition/dsm5/ • http://www.diigo.com/user/digizen/dsm

Comunicate

• Email: mario.nunez@upr.edu• Blog: http://www.vidadigital.net/blog• Twitter: http://www.twitter.com/digizen