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Monday 1 October 2012

The Political Economy of DSM-5 - By Professor Allen Frances - Courtesy of Psychology Today

The American Psychiatric Association just reported a surprisingly large yearly deficit of $350,000. This was caused by reduced publishing profits, poor attendance at its annual meeting, rapidly declining membership, and wasteful spending on DSM-5. APA reserves are now below ” the recommended amount for a non-profit (reserves equal to a year’s operating expenses).”

APA has already spent an astounding $25 million on DSM-5. I can’t imagine where all that money went. As I recall it, DSM-IV cost about $5 million and more than half of this came from outside research grants. Even if the DSM-5 product were made of gold instead of lead, $25 million would be wildly out of proportion. The rampant disorganization of DSM-5 must have caused colossal waste. One obvious example is the $3 million spent on the useless DSM-5 field trial—with its irrelevant question, poorly conceived design, and embarrassing results.
Because APA is left holding these huge IOU’s, it will be doubly desperate to begin recouping on its misguided investment. The bad financial report will ratchet up the pressure to publish DSM-5 in its current sorry state as scheduled next May—despite the fact that it has badly flunked its own field test and now still requires extensive editing and retesting before being anywhere near fit for use.

The only way to restore credibility to DSM-5 would be postpone its publication until it can be done right. This means reinstating the quality control step that was cancelled when DSM-5 kept failing to meet its own deadlines. Prematurely publishing a poor quality DSM-5 would be nothing less than a cynical business ploy—violating what should be APA’s sacred duty to protect the public trust

From the very start, APA treated DSM-5 as private publishing asset meant to throw off profit. Rather than encouraging the necessarily open process that Bob Spitzer recommended, all DSM-5 participants were forced to sign confidentiality agreements. to protect its ‘intellectual property’—as if this should ever trump getting out a quality DSM-5. APA is remarkably alert and aggressive at protecting its trademark and copyright, but surprisingly slack and sloppy in doing what needs to be done to produce a document anyone can trust at a price the association could afford.

Were any more proof needed that APA has forfeited its right to monopoly control of psychiatric diagnosis, this is the smoking gun. Psychiatric diagnosis has become too important to be left in the hands of a small, withering, cash strapped, and incompetent association that feels compelled to regard its bottom line as a higher priority than having a safe, scientifically sound, and widely accepted diagnostic system. The overall message couldn’t be clearer—APA has forfeited its right to hold the monopoly over psychiatric diagnosis. Guild interest should never trump public interest.

Psychiatry and psychiatrists shouldn’t be judged by the DSM-5 fiasco. The field is far better and deserves far better than its past leadership. It remains to be seen if the new APA leadership will clean house and insist that DSM 5 not be published before it can be trusted.

Allen Frances is Professor Emeritus at Duke University and former Chair of its Department of Psychiatry. He was Chair of the DSM IV Task Force. This post first appeared at Psychology Today.

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