1. DSM: ¿la biblia
o el malleus
mallefiracum
de los
profesionales
de ayuda?
Mario A. Núñez Molina

2. Reflexión
• “Los jueces de la normalidad están presentes
en todas partes. Nos encontramos en
compañía del profesor-juez, del médico-juez,
del trabajador social-juez, todos hacen reinar
la universalidad de lo normativo …”(Foucault)

3. The Malleus Maleficarum (1486)

4. Las brujas
• Estimados de muerte durante la inquisición:
600,000 to as high as 9,000,000 (over its 250
year long course);
• Casi todas las acusadas eran mujeres.

5. Kreisman y el DSM
• Jerold Kreisman says, "Well, all psychiatric diagnoses,
these days, are defined very clearly in the Diagnostic
and Statistical Manual. And, every few years, wise
psychiatrists go up to Mount Sinai, talk to God, and
define all psychiatric illnesses. If you're a manic-
depressive, you have three out of these five or four out
of these seven. Borderline Personality Disorder is
defined by having five out of the eight criteria." There
was, once upon a time, another book from which this
kind of scientific certainty was derived. It was the
Malleus Maleficarum. The certainty then was about
who was a witch.
– 'Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis (Kindle
Locations 1529-1532). Kindle Edition.

6. DSM

7. Criticas al DSM: Conflict-of-Interest
Disorder
http://www.newscientist.com/article/dn21580-many-authors-of-psychiatry-bible-have-
industry-ties.html

8. William Glasser
• “The DSM was not written to help people; it
was developed to help psychiatrists – to help
them make money.”

9. Conflicto de intereses
• Al presente, un 69% de los miembros del task force del
DSM-5 tienen lazos con la industria farmaceútica.
• Of the 137 DSM-V panel members (that is, workgroup
members) who have posted disclosure statements, 77
(56 percent) reported industry ties, such as holding
stock in pharmaceutical companies, serving as
consultants to industry, or serving on company boards
– http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.
pmed.1001190

10. Eli Lilly
• Whitaker writes that in the first quarter of 2009
alone, Eli Lilly gave $551,000 to NAMI [National
Alliance on Mental Illness] and its local
chapters, $465,000 to the National Mental Health
Association, $130,000 to CHADD (an ADHD
[attention deficit/hyperactivity disorder] patient-
advocacy group), and $69,250 to the American
Foundation for Suicide Prevention.
– http://www.nybooks.com/articles/archives/2011/jul/14/illusions-
of-psychiatry/?pagination=false

11. Conflicto de intereses
• 15 per cent of the work group members were
speakers' bureau members.
– http://www.newscientist.com/article/dn21580-many-authors-
of-psychiatry-bible-have-industry-ties.html

12. La transparencia no es suficiente
• However, transparency alone cannot mitigate
bias. Because industry relationships can create
a “pro-industry habit of thought” , having
financial ties to industry such as
honoraria, consultation, or grant funding is as
pernicious a problem as speaker's bureau
participation.
• http://www.plosmedicine.org/article/info:doi/10
.1371/journal.pmed.1001190

13. No se habla de los efectos secundarios
• Attention to adverse side effects of medications is
virtually nonexistent. Previous editions of the
DSM, including the latest text revision published
in 2000, glossed over the side effects of
psychotropic medications. Only two of more than
seven hundred pages of the main body of the
DSM-IV-Text Revision deal with diagnosing side
effects of psychotropic medication
– http://www.aaup.org/AAUP/pubsres/academe/2010/ND/feat/cos
g.htm (Cosgrove)

14. Efectos secundarios
• A typical patient, he says, might be taking
Celexa for depression, Ativan for
anxiety, Ambien for insomnia, Provigil for
fatigue (a side effect of Celexa), and Viagra for
impotence (another side effect of Celexa).

15. Prejuicios en los procesos de
diagnosticar

16. Clase social y sicopatología
• The "higher" the social class, the less likely an
individual was to become a psychiatric patient
of any kind; people in Classes IV and V
combined were 2 1/2 times as likely as people
in Classes I and II to enter psychiatric
treatment,
– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis
(Kindle Locations 205-206). Kindle Edition.

17. Mecanismo de control social
• Thus, diagnosis is a mechanism of social
control. It could do harm, or it could help, but
in either case it is a mechanism of social
control.
• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric
Diagnosis (Kindle Locations 302-303). Kindle Edition.

18. Premenstrual dysphoric disorder

19. "Premenstrual Dysphoric Disorder"
(PMDD)
• “PMDD was represented to the public initially
by Eli Lilly and later by other pharmaceutical
companies as a "distinct medical condition.”
– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis
(Kindle Locations 2872-2873). Kindle Edition.

20. Anuncio de Eli Lilly
• "PMDD affects millions of women.... but the
good news is that your doctor can treat PMDD
symptoms with a new treatment called
Sarafem" (Eli Lilly advertisement 2001).
– Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric Diagnosis
(Kindle Locations 2891-2892). Kindle Edition.

21. Sarafem-Prozac
• What women were not told in these ads is
that the psychotropic medication produced by
Eli Lilly to treat PMDD is Prozac, which had
been relabeled as Sarafem and manufactured
in pink and lavender capsules.
• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric
Diagnosis (Kindle Locations 2892-2894).

22. Video Sarafem
• http://www.youtube.com/watch?v=2TPtuPt_5
Uc&feature=related

23. FDA
• It is noteworthy that, in December 2000, the FDA
sent a warning letter to Eli Lilly, mandating that Lilly
cease using this ad for the following reasons: “The
imagery and audio presentation of the advertisement
never completely define or accurately illustrate
premenstrual dysphoric disorder (PMDD) and there is
no clear distinction between premenstrual syndrome
(PMS) and PMDD communicated. . . . The
advertisement is lacking fair balance because the
graphics accompanying the audio presentation of the
risk information are very distracting and minimize the
important risk information.” (Emphasis added.)
– http://www.aaup.org/AAUP/pubsres/academe/2010/ND/feat/cosg.htm

24. Beneficios para la industria
• It was reported that in the first six months
after the FDA approved fluoxetine
hydrochloride to treat the unproven entity
called Premenstrual Dysphoric Disorder
(PMDD), 2.5 million prescriptions for the drug
were written.
• Paula J. Caplan;Lisa Cosgrove. Bias in Psychiatric
Diagnosis (Kindle Locations 3200-3201). Kindle Edition.

25. Tratamiento natural
• eating smaller, more frequent meals to limit blood-
sugar fluctuations;
• cutting back on white flour and sugar intake (which
cause blood sugar levels to spike);
• and exercising regularly. Even a brisk 20- to 30-minute
walk three times a week, increases mood-boosting
serotonin levels, and helps with fluid retention and
food cravings. Nutritional supplements like
calcium, [B.sub.6] and magnesium also may help.
• http://findarticles.com/p/articles/mi_m0846/is_9_21/
ai_84599102/

26. Medicalización de la normalidad

27. Major depressive disorder
• DSM 5 would encourage the diagnosis of
'Major Depressive Disorder' almost
immediately after the loss of a loved one—
having just 2 weeks of sadness and loss of
interest along with reduced
appetite, sleep, and energy would earn the
MDD label (and all too often an unnecessary
and potentially harmful pill treatment).

28. La pena como depresión mayor
• For example, take the case of a man whose
spouse unexpectedly dies. For two weeks after
the death, he feels sad, doesn't want to go to
work, loses his appetite, has trouble sleeping
and concentrating. Currently, this is normal
grief. The DSM 5 suggestion would have this
be major depression.

29. Epidemias creadas artificialmente
• Ten percent of ten-year-old boys now take
daily stimulants for ADHD—”attention
deficit/hyperactivity disorder”—and 500,000
children take antipsychotic drugs. (se ha
triplicado el número en los últimos quince
años)

30. Attention deficit/hyperactivity disorder
• Attention Deficit/Hyperactivity Disorder. There
are 4 suggestions for DSM5 that would make this
existing overdiagnosis much worse.
– •The first change is to raise the required age of onset
from 7 to 12.
•The second is to allow the diagnosis based only on
the presence of symptoms, not requiring impairment.
•The third is to reduce by half the number of
symptoms required for adults.

31. • We don't have more attention deficit than
ever before-we just label more attentional
problems as mental disorder. (Allen Frances)

32. Otros nuevos desordenes
problemáticos

33. MND

34. MNC
• Minor Neurocognitive Disorder is defined by
nonspecific symptoms of reduced cognitive
performance that are very common (perhaps
almost ubiquitous) in people over fifty.

35. Binge eating disorder

36. Disruptive mood dysregulation
disorder

37. Disruptive mood dysregulation
disorder
• Disruptive mood dysregulation disorder is one
of the most dangerous and poorly conceived
suggestions for DSM5―a misguided
medicalization of temper outbursts. The
“diagnosis” would be very common at every
age in the general population and would
promote a large expansion in the use of
antipsychotic medications.

38. Paraphilic coercive disorder

39. • Paraphilic Coercive Disorder would expand
the pool of sex offenders who are eligible for
indefinite civil commitment because they have
a “mental disorder” to include cases of sexual
coercion.

40. Internet use disorder

41. • Diagnosis of "mental illness" is more an art
than a science. DSM-based research has
repeatedly shown very poor reliability and,
therefore, questionable validity. In a 2005
interview, Robert Spitzer, the architect of the
DSM, confessed candidly: "To say that we've
solved the reliability problem is just not true. .
. It's been improved. But if you're in a
situation with a general clinician it's certainly
not very good" (Spiegel, 2005, p. 63)

42. Patologización de la normalidad
• DSM5 would create tens of millions of newly
misidentified false positive “patients,” thus
greatly exacerbating the problems caused already
by an overly inclusive DSM4.7 There would be
massive overtreatment with medications that are
unnecessary, expensive, and often quite harmful.
DSM5 appears to be promoting what we have
most feared--the inclusion of many normal
variants under the rubric of mental illness, with
the result that the core concept of "mental
disorder" is greatly undermined. (Frances)

43. Occupy American Psychiatric
Association

44. Referencias
• A MOMENT OF CRISIS IN THE HISTORY OF AMERICAN PSYCHIATRY.
(n.d.).h-madness. Retrieved from
http://historypsychiatry.com/2010/04/27/a-moment-of-crisis-in-
the-history-of-american-psychiatry/
• Angell, M. (2004). The Truth About the Drug Companies: How They
Deceive Us and What to Do About It (1st ed.). Random House.
• Caplan, P. J., & Cosgrove, L. (Eds.). (2004). Bias in Psychiatric
Diagnosis. Jason Aronson, Inc.
• Carlat, D. (2010). Unhinged: The Trouble with Psychiatry - A Doctor’s
Revelations about a Profession in Crisis (1st ed.). Free Press.
• Cosgrove, L., & Krimsky, S. (2012). A Comparison of DSM-IV and
DSM-5 Panel Members’ Financial Associations with Industry: A
Pernicious Problem Persists. PLoS Med, 9(3), e1001190.
doi:10.1371/journal.pmed.1001190

45. • Horwitz, A. V. (2003). Creating Mental Illness (1st ed.). University Of
Chicago Press.
• Kutchins, H. (1997). Making Us Crazy. Free Press.
• Opening Pandora’s Box: The 19 Worst Suggestions For DSM5 -
Psychiatric Times. (n.d.). Retrieved May 2, 2012, from
http://www.psychiatrictimes.com/print/article/10168/1522341
• Watters, E. (2010). Crazy Like Us: The Globalization of the American
Psyche. Free Press.
• Whitaker, R. (2010). Mad in America: Bad Science, Bad
Medicine, and the Enduring Mistreatment of the Mentally Ill
(Second ed.). Basic Books.
• Whitaker, R. (2011). Anatomy of an Epidemic: Magic
Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness
in America (1st ed.). Broadway.

46. Referencias
• http://www.dsm5.org/Pages/Default.aspx
• http://www.ipetitions.com/petition/dsm5/
• http://www.diigo.com/user/digizen/dsm

47. Comunicate
• Email: mario.nunez@upr.edu
• Blog: http://www.vidadigital.net/blog
• Twitter: http://www.twitter.com/digizen