In the past week, I’ve seen some incredibly sensationalistic articles published about the upcoming DSM-5 and a letter recently released by the National Institute of Mental Health (NIMH). In the letter by Dr. Thomas Insel, director of the NIMH, wrote in part, “That is why NIMH will be re-orienting its research away from DSM categories.”

Some writers read a lot more into that statement than was actually there. Science 2.0 — a website that claims it houses “The world’s best scientists, the Internet’s smartest readers” — had this headline, “NIMH Delivers A Kill Shot To DSM-5.” Psychology Today made the claim, “The NIMH Withdraws Support for DSM-5.” (The DSM-5 is the new edition of the reference manual used to treatment mental disorders in the U.S.)

So is any of this true? In a word, no. This is “science” journalism at its worse.

Nearly three years ago, we reported on the kerfuffle over psychologists who were upset to find that the “mandatory assessment” fee they thought was, well, mandatory turned out to be entirely optional. The fee was being paid to the American Psychological Association (APA), the professional guild association for psychologists, to fund a legally separate organization, the APAPO, tasked with lobbying (mostly at the state level — not the federal level).

A class-action lawsuit against the APA was thrown out earlier last year on technical grounds (but with prejudice, suggesting a new lawsuit has a harder road to climb).

Despite that, a new lawsuit was recently filed in federal court in California “accusing the group of misleading its members into paying a fee used to fund its lobbying arm as part of their annual dues.”

“Insanity is doing the same thing over and over again but expecting different results.”
~ Rita Mae Brown

Ya have to admire psychologists who endlessly lobby state legislatures for the right to extend prescription privileges to their profession (with a little additional training). They won’t take repeated defeat as a sign that perhaps their efforts are… insane?

Illinois is the latest state to hand psychologists seeking prescription privileges a defeat, with NAMI Illinois siding on the side of not supporting the bills in front of the Illinois legislature. After intense lobbying by both sides of this issue, they concluded, “NAMI Illinois opposes SB 2187 and HB 3074 in its current form to expand prescriptions privileges to psychologists.”

When will psychologists learn?

California has some patient-friendly regulations on its books, meant to help patients get the care they need in a reasonable amount of time. One of those regulations is that patients shouldn’t have to wait more than 10 business days for a regular appointment with their health or mental health care provider.

Yet, Kaiser Permanente’s health maintenance organization in the state — rather than abide by the regulation — regularly made patients wanting mental health care wait longer than the 10 business days. In fact, in one case from 2010, the California Department of Managed Health Care (DMHC) fined Kaiser $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months! The new report found that anywhere from 17 to 40 percent of patients waited longer than 14 days for an appointment.

Last week, the DMHC was again at Kaiser’s doorstep, finding that Kaiser kept two sets of appointment records to try and circumvent this regulation — a paper appointment calendar and an electronic health record calendar. The DMHC cited Kaiser for “serious” deficiencies in how it manages and provides mental health care services to its patients.

Kaiser Permanente is one of those enormous health care providers that seems to have lost the plot — providing reasonable and timely health care for its customers.

My first introduction to the Diagnostic Statistical Manual (DSM), published by the American Psychiatric Association (APA), was standing in the kitchen of my parents’ home and witnessing my father in full rant.

My dad was a psychiatrist/ psychoanalyst of the old school. Which is to say he was brilliant, but also a man of his particular age. Which is to further say his fury was directed at the APA for taking homosexuality as a diagnosable mental illness out of the manual. It was 1973.

Hardly aware of what he was so upset about, I did hear him dramatically declare that he was withdrawing his membership in the APA. My dad loved being a psychoanalyst and he loved being a physician but he wasn’t that crazy (you should forgive the word) about being a psychiatrist. His prescription pad gathered dust as he focused on talk therapy. So his threat to quit the APA wasn’t idle. But it wasn’t like he was giving up his beloved couch.

Yesterday, the board of trustees of the American Psychiatric Association (APA) approved a set of updates, revisions and changes to the reference manual used to diagnose mental disorders. The revision of the manual, called the Diagnostic and Statistical Manual of Mental Disorders and abbreviated as the DSM, is the first significant update in nearly two decades.

Disorders that will be in the new DSM-5 — but only in Section 3, a category of disorders needing further research — include: Attenuated psychosis syndrome, Internet use gaming disorder, Non-suicidal self-injury, and Suicidal behavioral disorder. Section 3 disorders generally won’t be reimbursed by insurance companies for treatment, since they are still undergoing research and revision to their criteria.

So here’s a list of the major updates…

Do you tend to be touchy-feely?  Are you comfortable with a pat on the back, a gentle hold on an elbow or a high-five?

When we touch, how often we touch and how we respond to touch is influenced by a wide variety of factors.  Each culture has varying norms about what is acceptable social touch. Families and social groups within a culture have their own norms. A 2012 study in the Journal of Personality and Social Psychology, for example, found that men are more likely to touch women than vice versa.

And each individual has a personality style that may influence their comfort level with touch in social situations.

Social touching (for example, a pat on the shoulder)  is an important part of our interactions with others.  It can be calming, create bonds, express concern and solidarity, reduce anxiety and provide reassurance.

While attending the 28th Annual Rosalynn Carter Symposium on Mental Health Policy at The Carter Center last week, it occurred to me that mental health professionals are some of the worst when it comes to discriminating against people with mental illness.

They do this in insidious and subtle ways, suggesting a patient can’t do the things others without mental illness can do. Like hold down a job, get into independent housing, interact in social situations or even just go back to school and get a degree.

They also do this in more direct ways, by suggesting to their patients applying for a job or going back to school that, “If they don’t ask about mental illness, don’t volunteer that information.” Why not?

Why are mental health professionals helping to contribute to discrimination and stigma about mental illness by making these suggestions?

I have to wonder how helpful it truly is to be playing armchair psychiatrist, when you’ve never personally interviewed the person under discussion. Imagine all the things we could just hypothesize about any celebrity, based only upon a snippet of their public behavior (a snippet we carefully choose, of course).

There’s a profession that does something like this. They’re called publishers, and they publish tripe such as “Us Weekly” and “Star” magazine. They take a piece of gossip and write an entire story based upon nothing more than speculation, imagination and hype.

So I found it more than a little disappointing (but perhaps not surprising) to find a representative of the mental health profession, Dr. Keith Ablow, on Fox News Sunday night doing just that. He spoke during a “Medical A-Team” segment where a group of doctors talked about the vice-presidential debate.

Should a psychiatrist be discussing differential diagnoses of the Vice President of the United States — especially if they’ve never even met the man?

The American Psychological Association (APA) suffered a 7.6 percent loss of its members from 2010 to 2011 — from 91,306 to 84,339. While in recent years, the APA has suffered from smaller membership declines, this is the first time ever in the organization’s 120-year history it has suffered such a significant one-year decline in members.

Is this downward trend specific to the American Psychological Association, or are other professional organizations suffering similar losses?

And what’s to blame for this precipitous loss of members in a single year? A few factors come to mind.

A story last week caught my eye about a patient, Julie, who was surprised to discover that her psychotherapy notes became a part of her electronic health record at the hospital system that administered her care — Partners in Boston.

She found out that any doctor within the Partners system could access her record — including her sensitive psychotherapy notes — with no reason whatsoever. And she only discovered this privacy issue because her new internist initially refused to prescribe her needed medication because of “concern” about her psychiatric history — a history he had access to and read without the patient’s prior knowledge.

There’s a couple of problems here. But it’s a teaching moment for others implementing system-wide electronic health records. Psychotherapy notes enjoy special status in the health care community, and that special status should continue even in the age of electronic access.

I have been working in mental health for about 12 years. I listen to clients in crisis for many hours a day, providing support, empathy, interpretation and direction.

Therapists can easily lose track of their own issues, ignore their own problems, and at times have difficulty shutting off the therapeutic process.

In order to be a good therapist, it is necessary to take care of ourselves — our clients depend on it. Just because we know everything there is to know about stress management doesn’t mean that therapists can’t become mentally exhausted. If you are feeling “depersonalization” toward your clients or possibly yourself, you could be experiencing emotional fatigue.

Here are some ways that I like to keep balanced.