And then there was the field trial idiocy.

To see whether or not new diagnoses and new diagnostic criteria really work, whether they are useful, whether they create unforeseen consequences like too-high rates of diagnosis, they are field tested. Mental health workers in hospitals and private offices use the new criteria and report back on how they worked, and based on their experience the criteria are tweaked.

Field trials were supposed to begin in May 2010. But the criteria weren’t ready by then, which gave the dissenters more ammunition, as one of their criticisms was that the process was hopelessly inefficient and behind schedule. Over the summer, little was heard of the field trials, but every time I asked a question about the vagueness of various criteria or the complexity of the process by which the APA wants to start specifying the severity of mental disorders, the answer was, Wait until the field trials. In the meantime, certain deadlines loomed that were out of th APA’s control, especially the deadline for the update of the World Health Organization’s International Classficiation of Diseases (too complicated to go into here, but trust me, if the APA doesn’t get their DSM shit together before the ICD goes to press, they’re gonnna be one sorry bunch). So the pressure was on to get the field trials under way.

Finally, in October, the APA announced in a press release that the field trials had begun. I emailed to get some details and quickly discovered that the trials had not begun at all, except for one–the pilot study, which had been under way for months and whose results would determine the final shape of the field trials. Near as I could make out, the real start date was at least two months away.

You can’t blame the APA for not wanting this information out there. But why in the world would they announce that the trials had started when they had not? Did they really think no one would ask? I can only think of two possibilities, besides the obvious, which is that they’re too arrogant to think anyone will notice or care. First possibility: it could have been a Freudian slip–an unconscious revelation of something that they did not want in the light of day, truth coming to light in the form of a lie. Second, it could have been an Orwellian assault on language, you know, when an institution has so much power that it thinks it can control the meaning of words, as in War is Peace. 

Of course, there’s a third possibility: rank incompetence. That’s the explanation I think dissenters would go with, but it just seems too simplistic to me.

I have an article in the latest (Jan 2011) issue of Wired. It’s about the attempt to create a DSM-5. The process I witnessed makes the worst sausage factory look like a cupcake plant. You can read the article “The Book of Woe” in Wired, which I hear will be online soon–I’ll post the link. (Or you could buy the magazine, because much as information might want to be free, writers and editors want to eat.)

Anyway, a few items didn’t make it into the story. A couple of them are illustrative of just how hunkered down the American Psychiatric Association is, how doggedly determined the organization is to control the flow of information about the DSM, and how bad they are at doing it.

The story is largely about a group of unlikely DSM-5 dissidents–unlikely because they’re about as mainstream as psychiatrists get. Bob Spitzer and Al FRances, editors of the most recent revisions, Michael First, who was responsible for much of the criterion-writing in DSM-IV, and other long time psychiatric stalwarts are up in arms about DSM-5. About a year after they started their assault, the APA convened a committee to oversee the process–which was one of the suggestions the dissidents were making. The committee determined that the process was behind schedule and in disarray and thus publication of DSM-5 needed to be delayed by a year. When the APA heard from the factchecker that we were reporting that they had postponed publication in response to the dissidents the pr flack there insisted this was incorrect, that they had other reasons for convening the committee and for the delay, and that the timing was coincidental.

I guess you can’t blame them for this. Well, actually I think you can. What possible good does it do them to deny something so obvious? Clearly, it’s about pretending that the dissenters aren’t bothering them, that they’re so wrong they aren’t even worth listening to, and that just because the APA followed their suggestions, that doesn’t mean they were right. Which is such a ham-handed move. It reeks of petty squabble, of schoolyard brawl, of turf war.

Especially when you consider that the APA trustee who headed the oversight committee told me, on the record, that the committee was formed in order to address the concerns raised by Spitzer and Frances and the rest. She said it flat-out and unprompted, in passing really. I lucked out there–not being much of a reporter I didn’t even think to ask about something so obvious. So I didn’t even take note of it, and I’ll bet she didn’t either. I only remembered it when the APA started insisting that it wasn’t the case.

For various reasons, the magazine didn’t publish this part of the story, just let the APA “insist” that they weren’t listening, which is as stupid a strategy as one can imagine. Talk about drawing attention to yourselves in the wrong way! The APA can’t even get their propaganda straight.

Lea Carpenter, on Big Think, has a nice reading of my Harper’s piece. She compared me to David Foster Wallace, which made me blush. But I’m not complaining.

Well, it’s really yesterday’s news. According to US News and World Report, which got it from Science, scientists have a new theory about how antidepressants work: they increase the presence of a piece of RNA that interferes with the brain’s ability to manufacture the chemical that whisks serotonin out of the synapse. Less of that chemical, more serotonin pinging your receptors, less depression. Of course, every term in that equation is still in doubt. They’re not sure it’s really the “minimolecule” that causes the increased presence of serotonin, and they’re really not sure that increased serotonin cures depression.

Now, what’s really interesting about this–besides the discovery itself, which is undoubtedly interesting, especially if you’re into neuroscience–is that it’s, what, twenty-one years since Prozac came on the market, and they still don’t know how the SSRIs work. It’s a black box, and in this case the black box is your brain. I’d say the USN&WR buried the lede.

Evidently, my Harper’s article scooped the entire world by revealing, without even meaning to, some momentous news about our Secretary of State.

http://www.youtube.com/watch?v=jEWR5Bz2lTM