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Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.
In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and mental health experts said its new categories and "tick-box" diagnosis systems were at best "silly" and at worst "worrying and dangerous."
Some diagnoses - for conditions like "oppositional defiant disorder" and "apathy syndrome" - risk devaluing the seriousness of mental illness and medicalising behaviors most people would consider normal or just mildly eccentric, the experts said.
At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like "paraphilic coercive disorder" - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.
The DSM is published by the American Psychiatric Association (APA) and has descriptions, symptoms and other criteria for diagnosing mental disorders. It is used internationally and is seen as the diagnostic "bible" for mental health medicine.
More than 11,000 health professionals have already signed a petition (at http://dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.
"The proposed revision to DSM ... will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don't fit nicely into those boxes," said Peter Kinderman, a clinical psychologist and head of Liverpool University's Institute of Psychology at a briefing about widespread concerns over the book in London.
He said the new edition - known as DSM-5 - "will pathologise a wide range of problems which should never be thought of as mental illnesses."
"Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill," he said. "It's not humane, it's not scientific, and it won't help decide what help a person needs."
Simon Wessely of the Institute of Psychiatry, King's College London said a look back at history should make health experts ask themselves: "Do we need all these labels?"
He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognizing 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.
Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would "radically and recklessly expand the boundaries of psychiatry" and result in the "medicalisation of normality, individual difference, and criminality."
As an unintended consequence, he said an emailed comment, many millions of people will get inappropriate diagnoses and treatments, and already scarce funds would be wasted on giving drugs to people who don't need them and may be harmed by them.
Nick Craddock of Cardiff University's department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM's broad categories were going wrong.
Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.
Other examples of diagnoses cited by experts as problematic included "gambling disorder," "internet addiction disorder" and "oppositional defiant disorder" - a condition in which a child "actively refuses to comply with majority's requests" and "performs deliberate actions to annoy others."
"That basically means children who say 'no' to their parents more than a certain number of times," Kinderman said. "On that criteria, many of us would have to say our children are mentally ill."
By Anna Smolchenko , Laetitia Peron | AFP News – Wed, Oct 9, 2013
A Russian court Tuesday ordered that an activist be committed to a mental hospital after convicting him for his role in a protest against President Vladimir Putin, a move criticised as reviving Soviet-era punishments.
In its verdict, the Moscow court found activist Mikhail Kosenko, who suffers from a mild form of schizophrenia, guilty of participating in an anti-Putin mass protest and using violence against police.
The judge however ruled that due to his illness, Kosenko, 38, was mentally incompetent and must be admitted to a high-security psychiatric facility indefinitely.
"The court ruled that Kosenko undergo compulsory medical treatment," his lawyer Valery Shukhardin told AFP.
Diagnosed with "sluggish schizophrenia" -- a term for mild mental illness used in Russia -- Kosenko had been treated on an outpatient basis before his pre-trial detention.
His defence insists that he should not be hospitalised and continue treatment as an outpatient.
But a psychiatric report submitted to the court by the prosecution said his schizophrenia was so serious he needed to be committed.
"A conclusion by expert psychiatrists says that he is a danger to society and therefore should be isolated in a psychiatric facility," said Shukhardin.
"It's unclear to us where these conclusions come from. They are not justified by anything except the charges laid against him."
Kosenko was one of a dozen activists accused of mass disorder when a peaceful opposition protest suddenly descended into violence on May 6 last year, on the eve of Putin's inauguration to a third presidential term.
A group of Kosenko's supporters gathered outside the Moscow court, some holding white flowers that symbolise the anti-Putin opposition movement, shouting "Shame!" Nine people were detained, police said.
Kosenko had denied the charges, insisting he did not attack a policeman as alleged but simply pushed him away.
Shukhardin said the court ruling could see Kosenko spend several years in a psychiatric ward.
'Smacks of worst Soviet excesses'
Veteran human rights activist Lyudmila Alexeyeva, who has monitored the trial, called the ruling "a resumption of the psychiatric persecutions for dissent that were practised in the Soviet Union."
"Now they have started it again.... Butchers," she told AFP.
The Soviet Union regularly diagnosed political dissidents with mental illnesses and incarcerated them in psychiatric hospitals for years on end.
John Dalhuisen, Europe and Central Asia programme director at Amnesty International, said in a statement that the ruling "smacks of the worst excesses of the now defunct Soviet era."
The watchdog last week called Kosenko and two other activists "prisoners of conscience," saying the video footage presented in court did not corroborate the prosecution's charges.
The Moscow-based Independent Psychiatric Association said earlier this month that Kosenko's case would set a dangerous precedent.
"The political use of psychiatry has been resurrected," it said.
Kosenko has been held in pre-trial detention since June last year. When his mother died recently he was not allowed to attend her funeral.
Kosenko's lawyer said his health had deteriorated over the past month because he had not been issued the correct medication.
Russian opposition leader Alexei Navalny, who has also closely monitored the trial, called Kosenko "an example for us all."
The opposition has maintained that the scuffles with police at the May 2012 rally in Moscow came as a result of a police provocation.
Authorities, however, have said protesters deliberately attacked police.
Rights activists say the trial is part of a tough crackdown on the opposition after unprecedented protests against Putin's 13-year rule.
In November 2012, another participant in the protest, Maxim Luzyanin, was sentenced to four-and-a-half years in prison after pleading guilty.
A third participant, Konstantin Lebedev, was jailed for two-and-a-half years in April.
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