The "bible" of American psychiatry - a manual of mental health used around the world by doctors, consumers and insurance providers - has come under fire from a growing group of psychologists who worry that proposed revisions will feed into a culture of overdiagnosing, and overtreating, otherwise healthy people.
The Diagnostic and Statistical Manual of Mental Disorders, or the DSM, is undergoing its fifth major revision in the more than 60 years since it was first published by the American Psychiatric Association. The last update was in 1994, and the new manual is expected to be released in spring 2013.
Revisions to the DSM are often hotly debated, but after two decades of major, and frequently controversial, shifts in how mental health problems are diagnosed and treated in the United States, this latest update has become especially contentious, many mental health providers say.
Last month a group of psychologists with the Society for Humanistic Psychology posted a petition against many of the suggested DSM revisions, citing what they see as a broadening of the definition of mental health disorders, which, in turn, would lead to overtreatment with drugs.
7,000 signatures
The petition now has more than 7,000 signatures, and last week it won the support of San Francisco's Saybrook University, with roughly 60 faculty members who emphasize a holistic approach to treating mental illnesses.
"There's this propensity to push pills instead of looking at what's really going on with the person," said Saybrook President Mark Schulman. "When we saw in the DSM-5 that there was going to be a push in the direction of a more medical, less holistic way of doing things, we felt we should take a stand."
A work in progress
The American Psychiatric Association has posted an online response to the petition, welcoming critiques to and comments on the proposed revisions. Their response notes that the manual is still a work in progress and, as more scientific evidence becomes available, some of the changes may become more palatable to critics.
Since the last diagnostic manual update, research has increasingly pointed to biological causes for a wide variety of mental health conditions and, in response, treatment has turned toward pharmacological answers, some psychologists say. Drugs are being used to solve mental health problems that aren't problems at all, they add.
In 2010, 1 in 5 American adults was using some type of mental health medication, a 22 percent increase over the past decade, according to a report released last week by Medco Health Solutions, a pharmacy-benefits management company.
Therapy is still popular, but part of the problem is that there simply aren't enough trained counselors to fill the mental health need. Patients are turning to primary care doctors for medical relief from symptoms for everything from depression and anxiety to attention deficit disorder, many mental health providers say.
Because many primary care doctors rely on the DSM to help them understand and diagnose mental health problems, it's critical that the manual be as accurate and science-based as possible, say psychologists who have signed the petition.
While trained psychiatrists might be able to distinguish between a mental health disorder that needs medical intervention and a so-called normal human response to a difficult time or situation, primary care doctors may struggle.
Critics' concerns
Critics of the DSM update say that the task force assigned to make the revisions has suggested broadening the definitions of too many mental health problems, opening the door to even more diagnoses and treatments.
Grief after the death of a loved one, for example, may be included under the diagnosis of major depressive disorder. That means a person's grief could be labeled a pathological disorder, and not a normal human experience, said psychologist Brent Robbins, a professor at Point Park University in Pittsburgh and an author of the petition.
2-year-olds on meds
"Another diagnosis, dysphoric mood dysregulation disorder, is basically temper tantrums," Robbins said. "Next thing you know, you could have 2-year-olds on psychotropic medications."
Dr. James Scully, medical director of the American Psychiatric Association, said there's no doubt that the past two decades of research into mental health has opened the door to biological causes of disorders, but that doesn't mean that drugs are the obvious answer to treatment. And the new DSM, he said, will reflect that distinction.
"It's not the proposal to make it all psycho-biological. Even to know that it's biological does not mean the answer is pharmacology," Scully said. "Actual talking therapy changes the brain too, and that's one of the great discoveries of recent years."
Meanwhile, patients and their families may still find themselves in a rough spot between overtreatment of some conditions, and lack of sufficient care for others, said Dale Milfay, vice president of the National Alliance on Mental Illness in San Francisco.
"We're in a bind in this country with the drug companies pushing pills because they make a lot of money on people who don't need them, and the people who really do need them can't get them," Milfay said. "I get calls from families all the time who cannot get help for their loved ones."
E-mail Erin Allday at eallday@sfchronicle.com.
This article appeared on page A - 1 of the San Francisco Chronicle