Psychiatry manual's secrecy criticized

When it first appeared in the 1950s, psychiatry was dominated by Freud's model of psychological suffering, one that was resolvable by talking out the conflict with a therapist. Yet even then, drugs were appearing for relief of psychotic symptoms, and leadership in the profession has since passed to psychiatrists with an alternative model: biology and genetics as the source of emotional problems.

As the field has changed, the number of disorders in the DSM has tripled to 300, an increase paralleled by the rise in sales of drugs that pharmaceutical companies and psychiatrists tout as remedies for emotional suffering.

Some critics suspect that a quest for profits has encouraged the field to create mental illnesses out of personality quirks.

In his recent book, "Shyness: How Normal Behavior Became a Sickness," Christopher Lane traces how shyness morphed from a character trait into a pathological condition called "social phobia," which the DSM defines as "fears that he or she may do something or act in a way that will be humiliating or embarrassing." With disorders so broadly drawn, Lane wonders, who among us is sane?

It's an apt criticism, says David Kupfer, who is shepherding the DSM's revision.

"One of the raps against psychiatry is that you and I are the only two people in the U.S. without a psychiatric diagnosis," said Kupfer, head of the psychiatry department at the University of Pittsburgh.

Kupfer said he hopes to reduce the number of diagnostic categories in the forthcoming edition of the DSM, scheduled to appear in 2012.

He argues that scientific progress comes from formulating ideas, then seeing if others can shoot them down. If currently listed maladies fail that test, they'll be dropped, Kupfer said.

Meanwhile, Lane -- who has become something of a thorn in the side of the psychiatric community -- has irked some by obtaining the working papers of psychiatrists who produced the DSM-III and making plans to post them on his website.

Some of his finds read less like scientific discourse than like shtick from a Catskills comedian.

One syndrome under discussion at the time was "chronic complaint disorder."

Its supposed sufferers were largely "of Eastern European ancestry" and revealed their malady when asked how things are going.

"In those cases," the psychiatrists wrote, "the pathognomonic expression becomes, 'Oy vey, don't ask.' "

rgrossman@tribune.com

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(BEGIN TEXT OF INFOBOX)

About the new edition

What is it? The DSM is the authoritative psychiatric handbook defining mental disorders.

What's new? The American Psychiatric Assn. is revising it. The new version is expected in 2012.

Why does it matter? Prescriptions for psychiatric drugs are written in accordance with the DSM. Courts, social workers and insurance companies also use it in their decisions.

Why the fuss? Authors of the forthcoming fifth edition are pledged to secrecy, leading others to question whether science should be done behind closed doors. Disclosures of financial links between psychiatrists and drug companies raise the question: Is this a search for truth or for profits? Meanwhile, critics worry we're becoming a nation too quick to reach for pills.