A Response to the Charge of Financial Motivation

I had intended not to reply to the silly suggestion made by the DSM-V leadership that I wrote my critique out of financial motivations. I had expected that we would be conducting a useful discourse on the concrete issues and was surprised by the unenlightening personal exchange. Unfortunately, the DSM-V leadership refuses to discuss any of the substantive questions I have raised and instead, I am told, persists in the shallow rationalization that whatever I say is about royalties.

Let’s set the record straight so that we can redirect attention to the questions that need answering. My royalties from DSM-related books have totaled about $10,000 per year. I was always surprised they lasted this long, expected that they would end soon, and never regarded this as a motivation for anything. I did not mention the royalties in my commentary disclosure simply because it never occurred to me as I was writing.

What are my motivations and why did I write the commentary and subsequent communications (see the DSM section of www.psychiatrictimes.com)? Until recently, I had very little interest in DSM-V and felt the new team deserved a clear field. I learned 3 things at the recent meeting of the American Psychiatric Association (APA) that forced me to give up my previous complacency. Most worrying was the announcement that field trials were about to begin without any of the DSM-V options having been posted and vetted by the field. This is a recipe for damaging unintended consequences.

Second, I learned that subthreshold and premorbid disorders were still being seriously considered.

Third, I discovered that the DSM-V Task Force has had no reporting relationship to the research council-which may explain its many missteps.

I wrote the commentary that appears on the cover of this issue of Psychiatric Times out of a simple and disinterested concern that the work on DSM-V, unless corrected soon, would be harmful to patients, practitioners, and also to the APA. I don’t like being part of a controversy and this is no fun. Nevertheless, I felt I had a responsibility to point out the serious problems in how DSM-V is being done and to offer to recommendations on the basis of my experience.

It was my hope that the commentary would open a reasoned discussion. When the DSM-V leadership responded so defensively, I realized it would be necessary for the trustees to intervene. This is why Dr Robert Spitzer and I wrote to them. I will happily drop out of this controversy once the DSM-V process is on sound footing.

Which brings us back to the questions that have been raised repeatedly-and so far avoided completely. I repeat them once again and invite reply in the hope that it is never too late to have constructive discussions on how to improve the DSM-V process and product. Why not:

1. Post all the suggested wordings for the DSM-V criteria sets well before considering field trials?

2. Post all the literature reviews supporting the changes?

3. Post the proposed methods for conducting field trials?

4. Postpone field trials until there has been adequate time for the field to thoroughly review and critique the above postings and for the Work Groups to integrate the suggestions into the criteria sets that will then be field-tested?

5. Eliminate the confidentiality agreements?

6. Greatly increase the numbers and diversity of the pool of advisors?

7. As with all previous DSMs, establish the usual reporting chain from the DSM-V Task Force to the APA Council on Research?

8. Eliminate the artificial and unrealistic publication deadline of 2012 to ensure adequate time for a quality DSM-V.