The Los Angeles Times has a recent piece out (December 29, 2008) on how the Diagnostic and Statistical Manual of Mental Disorders, entitled DSM psychiatry manual’s secrecy criticized. DSM-IV-TRThe subheader for the piece is The Diagnostic and Statistical Manual of Mental Disorders is being revised under a cloak of confidentiality. Critics say the process needs to be open, and cite potential conflicts of interest. From the article:

An update is underway for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM, which defines the emotional problems for which doctors prescribe drugs and insurance companies pay the treatment bills. Psychiatrists working on the new edition were required to sign a strict confidentiality agreement.

Critics contend that the American Psychiatric Assn. should allow outside observers to review the scientific debate behind new and revised diagnoses.

Among the most prominent to speak out is the editor of the manual’s third edition, Dr. Robert Spitzer, hailed by peers as the most influential psychiatrist of his generation. If the DSM is often called the profession’s bible, then the DSM-III is the King James Version. Released in 1980, it set the standard by which others are measured.

Recently, Spitzer broke ranks by publishing an open letter to the profession protesting the confidentiality mandate.

A copy of Dr. Spitzer’s open letter is here. Here’s an excerpt from the letter:

[Below the fold, the Spitzer Letter and possible transgender/transsexual related issues behind the lack of transparency.]

The June 6 issue of Psychiatric News brought the good news that the DSM-V process will be “complex but open.” At the 2008 annual meeting, outgoing APA President Carolyn Robinowitz, M.D., stressed that with the development of DSM-V now under way, APA is demonstrating its commitment to “transparency” at a time of heightened public concern about pharmaceutical industry and other special-interest ties to medicine.

I found out how transparent and open the DSM-V process was when in a February e-mail to me from Darrel Regier, M.D., vice chair of the DSM-V Task Force, he informed me that he would not send me a copy of the minutes of DSM-V Task Force meetings as I had repeatedly requested over the past year. He explained that he and David Kupfer, M.D., chair of the DSM-V Task Force, had come to this decision because the Board of Trustees believed it was important to “maintain DSM-V confidentiality.” He noted that the Board had developed an “acceptance form” that all task force and work group members were required to sign that essentially requires work group and task force members to agree to not discuss with anybody anything having to do with DSM-V. The language is quite clear:

“I will not, during the term of this appointment or after, divulge, furnish, or make accessible to anyone or use in any way… any Confidential Information. I understand that ‘Confidential Information’ includes all Work Product, unpublished manuscripts and drafts and other pre-publication materials, group discussions, internal correspondence, information about the development process and any other written or unwritten information, in any form, that emanates from or relates to my work with the APA task force or work group.”

…It is hard to understand how the confidentiality agreements will benefit the process of developing DSM-V. Until they are no longer required, the DSM-V process can hardly be described as “transparent” and “open.”

Many trans people are already not pleased with who’s on the committee reviewing the updates for DSM-V. I know my gut-level guess with why the process of updating DSM-V is being secretive isn’t because the committee members are significantly concerned about possible financial links to pharmaceutical manufacturers, but instead because the committee doesn’t want to deal with angry, APA Names DSM-V Work Group Membersfrustrated trans people who don’t like how the discussion is going on updating the Gender Identity Disorder (GID) diagnosis. And frankly, my gut feelings have been wrong more than once — but it’s just one could make the case that it appears they’re hiding their deliberative processes to minimize public flack from trans people that want medical stigma removed from their diagnosis (in the way LGB people had the stigma of homosexuality removed with the issuance of DSM-III)…the appearance of impropriety verses a known impropriety.

This reminds me of one of my favorite colorful sayings from when I was in the Navy:

It looks like sh**, it smells like sh** — it must be chocolate, right?

Whatever the reason for the confidentiality agreements, I’m with Dr. Spitzer — updating DSM-V should be a “transparent” and “open” process that doesn’t require confidentiality agreements.


Further reading:

* WSJ Health Blog: Confidentiality of Psychiatric Manual’s Update Draws Gripes

* Spitzer Blog: DSM-V: Open and Transparent?

* Website: Diagnostic and Statistical Manual of Mental Disorders



* Gender-Variant Children And Transsexuals Will Likely Still Be Disordered In DSM-V

* Documenting The DSM-V And GID Controversy


Autumn Sandeen

Autumn Sandeen