Reflections on the DSM Process and Academic Freedom
After yesterday’s post on the Diagnostic and Statistical Manual (DSM) process “Retaliations and Beware of the Consequences” blew through the roof for record page views and stimulated similar confessions from other psychiatric bloggers about bullying by members of the American Psychiatric Association (APA), as well other commentary here and here and here. I seem to have wandered from a fairly tongue in cheek exercise in the DSM Shadow Team, founded to track the goings on of a secretive committee and have a little fun in the process, into a field of landmines.
This new article by Allen Frances, MD, who chaired the DSM-4 committee, criticizes the secretive approach by the current DSM-5 chair David Kupfer MD, who has insisted on secrecy, no note taking, confidentially agreements, and now I would add bullying of psychiatrists like myself who offer outside commentary. Dr. Kupfer has built up the Department of Psychiatry at the University of Pittsburgh into a research machine through developing the infrastructure of administrative personnel who help with the process of writing and submitting research grant applications for funding by the National Institute of Health (NIH). He is said to call out a “priority score” whenever he hears someone present research. Grants coming from Pittsburgh have the reputation of being technically excellent but not always exciting. It seems like he has brought this mass war enterprise approach to the DSM.
David Kupfer, MD, Chair of the DSM-5 Committee
All of this has gotten me reflecting on academic freedom. I mean, have not one but three organizations telling me to shut up (not counting the people in my personal life): the VA, my university (that which cannot be named here) and academic psychiatry. To whit, I am supposed to get approval to talk to the press from my local VA PR guy, but what this amounts to is that when I get contacted about something that they care about (i.e., Iraq), they shelve it and never get back to me. I mean, if you don’t think that pointing a gun at someone, pulling the trigger, and killing them can’t wreck your marriage or make you suicidal, that’s not my problem, so I don’t really get excited about getting censored about that stuff.
The current behavior of academic psychiatry in the DSM process is more troubling. By stiffling debate and creating a corporate type approach they are going against the very principles of science and academic freedom. One can only conclude that they feel insecure about the validity of their deliberations.
I also get upset about what I feel is my university treating me like an employee of a corporation rather than a professor in a university. I mean they should be glad to have their name associated with this blog when contrasted with other situations in which their name was associated with more questionable practices and they never said anything about it. For shame. And there are other professor bloggers who are much more lippy than I am and they list their universities on their blogs.
There are numerous examples of where a failure of academic freedom for exchange of ideas has had disastrous consequences, e.g. 30 million die in China applying Lisenko’s bogus scientific theories to agriculture which results in mass famine. In fact there is an organization dedicated to academic freedom. This is from wikipedia.
AFAF (Academics For Academic Freedom) [3] is a campaign for lecturers, academic staff and researchers who want to make a public statement in favour of free enquiry and free expression. Their statement of Academic Freedom has two main principles:
- that academics, both inside and outside the classroom, have unrestricted liberty to question and test received wisdom and to put forward controversial and unpopular opinions, whether or not these are deemed offensive, and
- that academic institutions have no right to curb the exercise of this freedom by members of their staff, or to use it as grounds for disciplinary action or dismissal.’
AFAF and those who are part of the campaign believe that it is important for academics to be able to express their opinions – not just full stop, but to put them to scrutiny and to open further debate. They are against the idea of telling the public Platonic ‘noble lies’ and believe that people should not be protected from radical views.
Well said.
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By Dan, June 26, 2009 @ 8:07 am
http://www.rbs2.com/afree.htm
Of course, the more is one restricted against academic freedom by a superior by title, the more there is to be concerned about regarding this superior and their stance.
Each individual has the freedom to hold and express paradigms that may or may not blend with existing paradigms. That’s the whole point of acquiring knowledge.
Knowledge is discussed and pursued, which should be conducted without any kind of restriction or interference by others.
Keep your freedom, Doug. Life is not a popularity contest.
By Marian, June 26, 2009 @ 8:17 am
All this reminds me of a Churchill-quote, someone I know uses as an e-mail signature: “You have enemies? Good. That means you’ve stood up for something, sometime in your life.”
By David Colquhoun, June 26, 2009 @ 9:25 am
I’d be very interested to know how many universities demand approval from a PR person(ie specialist in lying) before an academic is allowed to talk to the press. That is not, thank heavens, the case at UCL, and I’m not sure how common it is.
By Doug Bremner, June 26, 2009 @ 9:42 am
Hi David, it is actually the Veterans Administration (VA) which is is a federal institution and employs me as a part time physician and also supports part of my research program. Whether they have the legal right to over-ride my rights in the first amendment for free speech is an interesting question. “Academic rights” is also another interesting question which may vary by country (see Dan’s link above).
By Gina Pera, June 26, 2009 @ 10:36 am
“By stiffling debate and creating a corporate type approach they are going against the very principles of science and academic freedom. One can only conclude that they feel insecure about the validity of their deliberations.”
—-
Not to defend what is indefensible (and honestly, I just don’t know the history well enough to have an opinion), but I wonder how much the alleged secrecy, etc. springs from the groundswell of anti-psychiatry, anti-medication wingnuts on the Internet.
The vehemence and, frankly, blatant mental illness, behind much of the chatter would be enough to make one paranoid. The simplistic notions, the total rejection of science, the outright pathology in many cases, is enough to make even the most die-hard creationist blanche.
Moreover, when you have “healthcare” reporters such as NYTimes Gardiner Harris denying the existence of bi-polar disorder in children (excuse me…where’s his doctorate in neuroscience?), they can’t trust the media to get it right, either.
Let’s don’t even start with grandstanding politicians like Grassley — the patron saint of the “mental illness is a social construct” crowd.
By Marian, June 26, 2009 @ 10:52 am
Gina Pera: If the science was hard, what would they have to fear?…
By Gina Pera, June 26, 2009 @ 11:24 am
Unfortunately, many people are too uneducated to understand the science or too ignorant to accept that other people might just be smarter than they are.
I am polite enough to respond when spoken to, but you are clearly never interested in a discussion, Marian. So, please don’t knock on my door anymore looking for a fight.
By Marian, June 26, 2009 @ 12:02 pm
I don’t see, that we ever have had much of a discussion, as you yet would have to come up with some factual arguments. I don’t “discuss” ad hominem.
By Therapy Patient, June 27, 2009 @ 6:18 pm
You are a real hero, Dr. Bremner, for pursuing this and keeping it in the public eye despite the bullies.
By skillsnotpills, July 2, 2009 @ 9:07 pm
Having perused your site tonight, this is my last comment, and it is pretty damn harsh, but needs to be said.
After watching the fiasco of the 1995 elections that narrowly elected Harold Eist over Stephen Sharfstein over managed care issues as the driving theme that divided the candidates, I dropped my membership as I watched 48% of members vote for what was Dr Sharfstein’s unspoken platform of “managed care is here to stay, deal with it.” And now, active membership elected this bozo Dr Schatzberg as president. I do not really care when others will attack me for my Nazi analogies, but this is yet another example of how the ignorance or covert agenda of the masses in our field will feed on the innocence of those who mistakenly look to us as physicians for help and care.
As the issues take shape, the overall direction of psychiatrty is evil to me. I hope and pray someone with significance can expose the APA once and for all as the fairly much criminal element it has degraded to these past 10 years. I know that last statement is harsh and probably out of line.
So has been the leadership of my profession!!!