The history of disability is packed with alarming ideas and misconceptions. The news that the Diagnostic and Statistical Manual, DSM-5 has dropped Aspergers Syndrome from its formal classification of psychiatric conditions is cause for considerable fear among “aspie” advocates because so little is still known about it, and the decision to place Aspergers under the umbrella of autism spectrum disorders poses the possibility that people in need of rehabilitation services and educational assistance will now be given short shrift.
Back in the time of FDR Aspergers was cheerfully called “Little Professor Syndrome” by psychiatrists who thought the condition was endearing since those who have it are wonderfuly acquisitive. People with Aspergers tend to have a keen command of facts and a concomitant inability to connect with others. Little Professor.
Some years ago I spoke with a well regarded psychiatrist in Columbus, Ohio who, by means of the promise of anonymity affirmed for me that psychiatry is not a science, adding that “the worst people, the lowliest medical students go into psychiatry”. If this seems pejoratively subjective let’s consider the DSM-5 more broadly, for it purports to be a scientific document when in fact it lacks research credibility on many levels. Dr. Allen Frances wrote on Psychology Today’s blog about the grievous research errors that have been rather willfully incorporated into the DSM-5:
The DSM-5 Task Force originally planned two sets of field trials, the second of which was meant to provide quality control to correct whatever weaknesses would be exposed in the first. But along the way, the field testing got far behind its schedule and the quality control step was quietly cancelled. No explanation was ever offered, but it seemed likely that DSM 5 was being rushed to press so that APA could reap publishing profits.
What is more troubling is the following:
Dr. David Kupfer now wants us to believe that the recently published results of the DSM-5 field-testing somehow serve to justify the inclusion in DSM 5 of extremely controversial and much feared changes. This is a terribly misleading claim. Independent of all the other criticisms of DSM-5 (and there are plenty), the poor results of the field trials must have been a major disappointment to the Task Force. Dr Kupfer is now making a desperate attempt to salvage the failed project by putting an unrealistically positive spin on its results.
Our forty-year experience in reliability testing for DSM-II, the RDC, DSM-III. and DSM-IV makes clear what are acceptable and what are unacceptable kappa levels. There is no way of avoiding or cloaking the stark and troubling fact that the DSM-5 field trials produced remarkably low kappas – harking back to the bad old days of DSM-II.
http://1boringoldman.com/index.php/2012/10/31/humility-2/
Equally disturbing, three of the eight diagnoses tested at multiple centers had widely divergent kappa values at the different sites – hardly a vote for their reliability. Even worse, two major diagnostic categories [Major
Depressive Disorder and Generalized Anxiety Disorder] performed terribly, in a range that is clearly unacceptable by anybody’s standard.
http://1boringoldman.com/index.php/2012/10/31/but-this-is-ridiculous/
Dr. Kupfer has been forced to drastically lower our expectations in an effort to somehow justify the remarkably poor and scattered DSM-5 kappa results. There is, in fact, only one possible explanation for the results- the DSM-5 field trials were poorly designed and incompetently administered. Scientific integrity requires owning up to the defects of the study, rather than asking us to deviate from historical standards of what is considered acceptable reliability. It is not cricket to lower the target kappas after the study results fail to meet reasonable expectations.
Diagnostic agreement is the bedrock of our system -a non-negotiable bottom line. The simple truth is that by historical standards, the DSM-5 field trials did not pass muster. Dr Kupfer can’t expect to turn this sow’s ear into a silk purse.”
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It’s important to remember that there are lives in the balance. The decision of Dr. Kupfer and his team to eliminate Aspergers from the manual while shoe horning several disorders together is as faulty as anything we might have seen some 70 years ago in the psychiatric field.
Planet of the Blind 