Critics such say there's a damaging conflict of interest with the financial ties between drug companies and experts who are revising the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), as well as guidelines on the best treatments.
This question has been a big topic of debate not just in scientific and academic journals it also concerns the public welfare. This is because the experts are making it possible for financial profit to affect decisions about who needs treatment, whether they are prescribed medicine and which ones, says Lisa Cosgrove, a psychologist at the University of Massachusetts-Boston.
The DSM appears to be more a political document than a scientific one. Each diagnostic criteria in the DSM is not based on medical science. "No blood tests exist for the disorders in the DSM. It relies on judgments from practitioners who rely on the manual," says Lisa Cosgrove of the University of Massachusetts Boston.
Approximately 160 experts are appointed by the American Psychiatric Association are updating the manual, expected in 2011-2012. For the first time the psychiatry association is now required to publicly disclose all industry ties. Sixty-eight percent of task-force members report economic ties with drug companies, Cosgrove says. These links include the experts being on corporate boards, hold stock or collect money as advisers for pharmaceutical companies.
The DSM tends to pathologize normal behaviors. For instance, the label "Anxiety Disorder" can be given as a result of some kinds of normal and rather healthy anxieties but the DSM will have experts view it and treat it as mental illness. In addition simple shyness can be seen and treated as "Social Phobia", while spirited and strong willed children as "Oppositional Disorder". Consequently, many psychotherapists, regardless of their theoretical orientations, tend to follow the DSM as instructed.
Daniel Carlat, a Tufts psychiatrist who publishes monthly called The Carlat Psychiatry Report states, "In psychiatry, many diseases are treated equally well with medication or therapy," Carlat says. "But the guidelines tend to be biased toward medication" because it's costly to make and study drugs.
The manual is of enormous importance to pharmaceutical firms, as the Food and Drug Administration will not approve a drug to treat a mental illness unless the condition is in the DSM. Drug companies then can market approved medications to physicians and consumers. Much is at stake. Antipsychotics, which had $14.6 billion in sales last year, were the top-selling class of U.S. medicines; antidepressants brought in $9.6 billion, says IMS HEALTH.
"This is one of the most important medical documents we have in this country, yet the public doesn't have relevant information about the experts involved in developing and revising it," said Sheldon Krimsky, a Tufts University professor.
"The very vocabulary of psychiatry is now defined at all levels by the pharmaceutical industry," said Dr. Irwin Savodnik, an assistant clinical professor of psychiatry at the University of California at Los Angeles.
According to his calculations, the original 1952 DSM manual contained 107 mental health disorders. By the fourth edition in 1994, the number had more than tripled to 365.