Tuesday, 14 February 2012

Just What is DSM5?

Oh no! I've got DSM5. Is it as bad as the herpes-simplex virus (with apologies to Eddie Murphy!)? Just what is it?

Recently, my time line has been infiltrated by Tweets telling me to be worried about this.These Tweets tell me it is a bad thing. But I find myself asking, why is it a bad thing?

After a little bit of investigation I now know why it is a bad thing and I shall try to explain why now.

But first...back to me!! (as my wife would say, my favourite subject!!)

ATOS. They have assessed me for a myriad of benefits. I have a plethora of clinical psychologists telling me I am unfit to work. There is only one person I know who thinks I can work - Me (not quite true, but it makes the point - read on!!)! When I go to an ATOS interview I try to back up the Doctors evidence with my testimony!! However, the mistake I make is that I must come across as very optimistic because ATOS manage to disagree with the specialist opinions and judge me fit to work, walk, run, join the Royal Marines, go into Space and save the human race from the oncoming apocalypse of an asteroid collision (OK, I am being a little bit silly here, but you get the point!!). I have evidence that ATOS are incompetent because my award from them of c 20% Industrial Injury Disability Benefit was increased at Tribunal(s) to c.80%.

But I am lucky with IIDB.

Not so lucky with DLA. (Disability Living Allowance)

As my MP tells me when I discuss it with her, these two different benefits are judged by different criteria. The rules are different. DLA, in my view, fails to recognise that not every handicap has a physical manifestation. Lose a leg and you get 100%. Because you can't walk. You can, of course, walk with an artificial leg but that is rightly judged to be of not sufficiently good quality so the award stays the same. With remarkable joined up thinking the Government has recognised this, but I suspect that rather than extend DLA to cover people like me they will instead disqualify people who can walk with artificial legs!
However, my cognitive damage means that whilst I have an arm &  leg my brain does not quite recognise them as belonging to me. Imagine that you have slept on your arm and it has "gone to sleep". When you come to use it, it feels "tingly" and uncomfortable and doesn't quite do what you want it to! Take away the "tingly" sensation and you then have an idea of what my right hand side feels like.
This basically means that I don't have full control of all of my movements (but don't worry, I have been given the all clear to drive!) and it takes a silly amount of mental concentration to do anything. Again, imagine being drunk and trying to act like you're sober. It takes a lot of effort & concentration and is never really successful!
The situation is that I can compare my slightly spastic right hand side to my normal left hand side and analyse the differences. However, when I tell ATOS about them the only question they have is can you walk? "Yes" I say, "but it is like I have the most advanced artificial leg ever". They don't hear that - tick the box, disallow DLA Mobility Component.

But, it is not their fault. Those are the rules they work to. I do not believe that Cognitive Impairment/ Mental Handicap is treated equally alongside physical handicaps. I have a leg so I am pigeon holed into the able to walk category without any thought.

You can see a missing limb -That person is handicapped.
You can't see Brain Injury - I can't see anything wrong with him! That person must be a benefit scrounger.

Until the rules, law makers, politicians and Doctors in General,  recognise how Traumatic Brain Injury and other invisible illnesses impact upon peoples lives, I will always be a second class disabled person.

So, how does this relate to DSM5?

In my case the Doctors recognised my impairments and I used that to fight for a better award where the system allowed me to. Bits of my brain do not work properly and the impact of that can be quantified by doctors. Importantly, medication does not help. There is not a memory pill they can prescribe. There is not some anti-spasticity drug they can give me. Prozac makes me happier but I have a condition. Bits of my brain do not work.

DSM5 is the bible of psychiatry: how disorders are numbered, classed etc. which all reflects on assistance needed. It is the progression from DSM4 etc

DSM5 is reported to simplify the diagnosis of some conditions to such an extent that conditions are not specific to the patient and become generic. How can you fight for what you believe you deserve if medical reports are not specific enough to identify your problems. If you have no evidence ATOS win and DSM5 could be a step towards restricting information given to patients.
 "You don't need to know what's wrong with you. I don't need to know exactly. Just take 2 of these pills twice a day and you're cured."

As an accountant, comparing DSM4 to DSM5 is like comparing UK Generally Accepted Accounting Practice (GAAP) to US GAAP.

UK GAAP is Principle based -The Accounts give a True and fair view of the condition of the enterprise.
US GAAP is Rules based - if this do this, if this do this, etc.

This difference is why Enron happened under US GAAP and would in all probability not have happened if they had to report under UK GAAP. Clever Americans structured transactions in such a way that liabilities Enron took on did not have to be shown as liabilities of Enron under the US accounting rules. We all now that if you over-borrow eventually people call in their debts and if you can't pay you destroy the Global Economy!

DSM5 is more prescriptive than DSM4. Psychologists fear this US manual (the US seem to like rules!) would lead to over diagnosis in legal cases, widen the diagnosis of mental illness generally and for cost reasons pigeon-hole patients into fewer discrete diagnosis and treat more conditions with drugs rather than counselling.

Why does this matter? In my journey through ATOS assessment to Lower Tribunal to Upper Tribunal back to Lower Tribunal it was me and my medical evidence vs ATOS and their evidence. My medical evidence was compelling, theirs was not. Their doctor was not a trained psychologist!! So my medical evidence mattered. No two head injuries are the same. Every one is unique. There is no infallible link between cause and effect. You can wake from a deep coma (GCS4) and be normal (you know what I mean!!). You may wake and be bed bound. Diagnosis of the cause does not correlate to patient outcomes. It is much much much more complicated than that.

What DSM5 does, I believe is to simplify invisible conditions and cognitive impairments into compartments that can be treated with medication X/ Y/ Z/ etc. I have heard it suggested that shyness could be treated with medication. We need to be worried about this!


The diagnosis should give a True and Fair View of the overall state of the patient. That is all that we are saying.

With Thanks to @sparklijellibean & @britishroses1

1 comment:

  1. That was a wonderful summation of the Atos incompetencies in action. But please don't worry too much about DSM5 - if it ever gets off the ground!

    What you haven't said is that ICD-10 is more often used in the UK for codings. What's more, even in the USA, ICD-10 published by the World Health Organisation is to be adopted (although they keep delaying the date) as the official diagnostic manual. ICD-10 is now on the way to becoming ICD-11 and uses different empirical data to generate its criteria. The DSM followed it for a while, but it's uncertain whether this new version 5 will do that. DSM5 seems in some respects to be adopting US market-led factors, this time, as some critics say. Let's see. I'm sure there are going to be a few heavy arguments still to come!