Introducing Allen Frances

Allen Frances was the editor of the DSM-IV, first published in 1990.  He is now the fiercest critic of its next major revision, the DSM-5.  For over three years, he has been blogging weekly to this end at Psychology Today.  This week I will summarize his steady drumbeat.  I hope soon to publish an open letter to him.

Frances' complaint in a nutshell is that the DSM-5 creates fad diagnoses and changes criteria of older diagnoses to medicalize a whole range of normal behavior and miseries.  The link lists these problem diagnoses and a number of the following points, in an article published all over town last December.

These issues have been discussed widely, in public and private circles.  I am not qualified to address each point, though I did give a series over to one of them, the bereavement exclusion.  The best of the batch, if I do say so myself, is Grief/Depression III - Telling the Difference, which got quoted in correspondence among the big boys.

Looking Under the Hood - A Better Depression Diagnosis?

Corrected July 7, 2013

Maybe my writer's block is an Ecclesiastes issue.  There is nothing new under the sun.

But finally, there is.  No, not the DSM.  Keep reading.

The DSM. Sigh.

But regarding the DSM, and it makes no difference at all which edition, you have to wonder when somebody who is suicidal, losing weight, irritated at the drop of a hat and can't sleep gets the same diagnosis as somebody else who is immobile, gaining weight, couldn't be bothered about anything anymore and sleeps the night and day away.  It's all depression -- the DSM's junk drawer.

Finally, somebody thought to sort the junk drawer, by looking inside the brains of these two sorrowful souls, both taking the same meds for God's sake.

PET Scans - Looking Under the Hood

Helen Mayberg and her team at Emory University School of Medicine used PET scans to look under the hood (to use John McManamy's favorite metaphor).  PET scans use a radioactive tracer to determine where glucose is being used in the brain, i.e., what part of the brain is busy.

The Power of Apology

First, a nod to our excrutiatingly polite neighbors to the north, on the Power of Apology from Scott Stratton:

Next, inspired by Scott and in honor of Magna Carta Day - a rerun of last year's Entitled to an Apology?

Perhaps because a central feature of both hypomania and depression is irritability, and because a characteristic of the "bipolar temperament" is a certain tendency toward an attitude of entitlement, interpersonal disputes tend to be common in this patient population. -- Ellen Frank, Treating Bipolar Disorder

Landfill Harmonic

I promised a series --



If the world sent you garbage, send back music.

Robert Gupta - Music as Medicine

This oughta be the start of a series...

Rx for Joy - Joanne Shortell

Joanne Shortell took me up on my call for guest bloggers.  I am glad she did, as I learned of a blogger and mental health advocate I'd like to introduce to you.  Joanne has three websites.  Strongly Bipolar is a blog similar to Prozac Monologues.  Maevetour.blogspot.com/ is the source of the following piece.  And Servicepoodle.com gives more information about the issue it discusses.  

Rx for Joy Can Be Written by any Therapist in the U.S.

My current therapist is a nurse practitioner who can prescribe psychiatric drugs.  My previous therapist was an MSW who could not.  Both, however, could write a prescription for an emotional support animal (ESA).  A short, simple letter (see sample below) from a doctor (any medical doctor, not just a psychiatrist) or any therapist will allow a person with a psychiatric disability or a chronic pain condition to have pets in no-pets housing, to avoid any pet deposit or pet fee, and to avoid size limitations or species restrictions.  The person with the disability gives this to their landlord or co-op/condo board as a request for a reasonable accommodation.  (See link: How to Get an Emotional Support Animal.

Why should I prescribe ESAs?

And Now For Something Completely Different

Glad he cleared that up!