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Posted on December 30, 2008 at 3:36 AM

Sarah Rubenstein from the Wall Street Journal Health Blog has explained that there is a concerning development regarding the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders: it’s being written in secret.


The authors of the entries for this latest version of the Bible of mental health has been asked to sign a non-disclosure agreement. The burning question is: why? The second question, of course: is it ethical?

There are many reasons for why a NDA could have been asked of the DSM authors–the APA surely knows that leakage of what authors wrote in the new DSM is bound to cause controversy and the slow trickle of that controversy over time, as each author reports what he or she wrote would cause real political problems for the APA and put a cloud over the DSM-V.

Moreover, unpopular opinions voiced by authors, disclosed before the manual was published, could result in pressure being put on the APA to retract or revise that entry before the 5th version is even printed. History has certainly seen its ups and downs with a variety of entries related to controversial topics classified as “mental defects”. Perhaps the APA is hoping to avoid such controversy by releasing the manual all at once–avoiding many of these problems.

The ethical question is much tougher to answer. Asking clinicians and academics to remain silent is, of course, their choice. It is not a breach of academic freedom if they freely choose to sign the NDA. Nor does it suggest that they have something to hide–simply that they will not discuss their opinions until the entire manual is released. In a way, it’s not that different from a medical journal article being embargoed until the journal is released and a press release is sent out to the press.

Given the fact that this version of the DSM will be taking on such controversial topics such as “gender identity and addictions such as shopping and eating”, it is no wonder that the APA would prefer to keep the lid on until the entire manual is released and let its critics attack the manual in its entirety rather than piecemeal. A political tactic, for sure, but I’m not so sure it’s an unethical one.

Summer Johnson, PhD

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