Dr. Jane Costello has had enough of DSM-V, and has quit the prestigious DSM-V Work Group on Disorders in Childhood and Adolescence. Her letter of resignation has been making the rounds (with her permission); I've reproduced it below, or you can access it directly here. Dr. Costello is a full Professor at the Duke Institute for Brain Sciences where she co-directs the Center for Developmental Epidemiology, and she is an international expert in understanding the course of mental illness across the life span.
Essentially, Dr. Costello resigned because she feels that the DSM-V process is being rushed to completion without an adequate scientific basis:
"When we began this process [she is referring to the DSM-V work group], we agreed that changes would only be made if there were empirical evidence to support them. Sometimes (as with Charlie’s work on preschool PTSD) this has been the case. But as time has gone by, the gap between what we need to know in order to make revisions and what we do know has grown wider and wider, while the time to fill these gaps is shrinking rapidly. More and more, changes seem to be made for reasons that have little basis in new scientific findings or organized clinical or epidemiological studies."
I encourage you to read her entire letter--it's a fascinating glimpse into the sausage-making process which is how a profession's bible gets constructed.
But wait! There's more!
Dr. Robert Spitzer has sent around this letter written by both himself and Allen Frances to the APA Board of Trustees in which they call for the appointment of a "DSM-V quality control committee" to oversee what they view as a broken process. Their letter recaps some of the same arguments Frances made in this his soon-to-be-published editorial (which I covered in this post) while adding five specific steps that need to be taken.
As William Butler Yeats wrote in his poem The Second Coming, "Things fall apart; the centre cannot hold... " The Fifth Coming of DSM threatens to rend the fabric of American psychiatry. Let's hope some cool heads in the APA's leadership can find a way out of this mess.
Jane Costello Resignation Letter from DSM-V Work Group to Daniel Pine March 27, 2009