Source: USA TODAY

Psychiatry’s battle-scarred bible of mental disorders — known as the DSM — continues to face a barrage of criticism even as the latest version (DSM-5) is just days away from official release.

The Diagnostic and Statistical Manual of Mental Disorders has been published since 1952 by the American Psychiatric Association to identify and classify mental disorders. Its last major revision was in 1994. With every revision, there are critics.

But among the legions roiling against this new version, a literary assault has now emerged. An array of books strategically timed to the new version being released at the organization’s annual meeting in San Francisco (which begins Saturday) are largely aimed at its failings.

“This is not just an academic debate,” says psychiatrist Allen Frances, who was chairman of the DSM-IV task force. “It’s not just inside psychiatry. It has a huge impact on how lives are lived, how mental health dollars are spent and on the public health of the country.”

His book, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, is out Tuesday.

“The reason there is so much controversy about DSM-5 is that psychiatric diagnosis has become, if anything, too important — not only in clinical decisions but also in school services, disability and in the courtroom. There’s a tremendous amount at stake,” says Frances, of Coronado, Calif., a professor emeritus at Duke University in Durham, N.C.

Because the DSM contains a detailed list of psychiatric disorders, it’s a guidebook for the U.S. health care system and insurance coverage. Revisions aren’t taken lightly. This latest took more than a decade and included more than 1,500 experts and extensive public comment.

“When DSM-5 happened, everything was up for grabs. That has the risk of causing changes to be made that really didn’t need to be,” says Michael First, a professor of clinical psychiatry at Columbia University in New York who has been an editorial consultant for the DSM-5. He says any future revision will be a modification and will be termed 5.1, etc., which is why they switched from Roman numerals.

The common theme of these new books is to take aim at the heart of the manual.

Psychotherapist Gary Greenberg, of New London, Conn., has written about the DSM for more than a decade and says the DSM disorders are “simply collections of symptoms that some experts agree constitute mental illnesses. There’s not a single diagnosis in DSM that lives up to the standards of medical diseases.”

“If I as a therapist tell you (that) you have a mental disorder, it’s not the same thing as my telling you you have diabetes or cancer because diabetes and cancer are diseases that can be confirmed through biochemical findings. They meet the requirements for a disease in the way we generally think of a disease. There is not a single disorder in DSM-5 or any DSM that does that,” says Greenberg, author of The Book of Woe: The DSM and the Unmaking of Psychiatry, out earlier this month.

“The whole disease model that underlies the DSM has been an utter scientific failure,” says Stuart Kirk, a professor emeritus of social welfare at UCLA, who has been tracking DSM for decades. “There’s not a single biological marker for any of the 300-plus disorders. What we do instead is descriptive. This describing is creating a disorder and pretending it’s a medical illness rather than just human behavior.”

Kirk is co-author of Mad Science: Psychiatric Coercion, Diagnosis, and Drugs, out last month.

In his book, The Intelligent Clinician’s Guide to the DSM-5, out last month, psychiatrist Joel Paris of McGill University in Montreal suggests that DSM has some pluses but a lot of minuses.

“The strong points would be that the manual does provide a useful guide to severe mental illness and it always has,” he says. The closer that it gets to what people would consider normal behavior, the less useful the DSM is, he says.

Psychiatrist Michael Taylor, of Ann Arbor, Mich., author of Hippocrates Cried: The Decline of American Psychiatry, out last month, says psychiatry has to go back to the medical model for disease.

“The reason why so many of the syndromes don’t work out when they do field trials is that they don’t exist in biological reality,” he says. “They only exist in the DSM.”

The focus on biomarkers and away from symptoms got attention just weeks ago when a blog post by Thomas Insel, director of the National Institute of Mental Health, said the DSM is “at best, a dictionary, creating a set of labels and defining each” and that “its weakness is its lack of validity.” He says NIMH will reorient its research away from the manual because “DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.”

First says psychiatrists had hoped DSM could further research into the cause of mental disorders, but says “in that area, the DSM, unfortunately, was not successful. It was shown to be not useful for guiding research.”

Insel says NIMH will focus on a new system called Research Domain Criteria, (RdoC) to find causes of disorders, but it’s just getting underway and is not an immediate change, which means the DSM prevails.

According to the association, the last version, DSM-IV, has been worth about $5 million a year to the group in terms of book sales and related materials. The new version costs $199 for hardcover and $149 for the paperback. A comparably priced electronic version will be available later this year.

Rather than the periodic revisions of the past, First says DSM “should be modified when the science shows something needs to change.”

Copyright © 2013 USA TODAY, a division of Gannett Co. Inc.

Source: USA TODAY

When young American mothers wrestle with the daily struggles of parenting, where do they look for advice?

Increasingly, anywhere but here.

Call it the parenting melting pot, as mothers build on the American framework of raising children by importing the best practices of other cultures — whether the laissez faire approach of the French to the give-them-space allowances in Iceland to the unforgiving rigidity of China’s “Tiger Moms.”

This search for just the right parenting mix goes well beyond the U.S.-based books and myriad mommy blogs, embracing a global view that has become more a way of life than a trendy divergence.

“I wanted to read about a different outlook, on making your kids more a part of your family, instead of the center of your family,” says Rebecca Gordon, a 35-year-old New Yorker with a 3-month-old daughter.

Gordon, who on Sunday will celebrate her first Mother’s Day, joins many of her peers in venturing beyond the 50 states. Several recent books about parenting practices around the world have even become top sellers. And, since these moms have grown up largely with the Internet, are often well-traveled and have a diverse group of international friends, thinking globally is almost second nature.

Such interest doesn’t surprise Jennifer Lansford, a research professor at the Duke University Center for Child and Family Policy in Durham, N.C.

“As the world becomes a more global place, there is interest from parents in many countries about what parents in other countries are doing,” she says.

A developmental psychologist, Lansford has since 2003 studied parenting in nine countries, including the USA. She says most parenting research comes from Western industrialized countries and has left out the “vast majority of the world’s children,” but that’s beginning to change. Later this month, she will present her findings at a conference in Sweden where researchers from China, Italy, Jordan, Kenya, the Philippines and the USA will discuss parenting across cultures.

Sarah Schoppe-Sullivan, an associate professor who teaches child development courses at Ohio State University in Columbus, makes sure her students read about parenting philosophies elsewhere.

“The idea is not necessarily to adopt one of these perspectives, but to calm down because there are different ways to do things,” she says.

Emma Swift, 34, whose four kids are ages 4 to 14, was born in Germany and moved to Iceland when she was 5. She’s been in the USA nine years and now lives in Madison, Wis., where she says differences are apparent at the pool.

“We let them make mistakes in Iceland,” she says. In Madison, “there are lifeguards at every corner. As soon as a child goes into a run or walk, the lifeguards will be yelling.”

THE WEST VS. THE REST

Erin Black, 39 and a mother of three from New York, points to the emotional and physical strains inherent in American culture as a reason to seek “clues” from abroad.

“I think when you look at the depression, obesity and anxiety in our country’s children, that is fairly unique to America,” says Black, whose children range in age from 1 to 6.

Rachel Rodgers, 31, of Rapid City, S.D., has read books and blogs about motherhood in other countries, including France and Africa, both places she’s traveled.

“I think it’s part of growing up in my generation with so much information at our fingertips,” Rodgers says. “We have a natural inclination to over-research everything,” says the lawyer with a 19-month-old daughter, and a son on the way in June. “That’s what we’re used to doing.”

Jasjit Sangha, a researcher at the Center for Women’s Studies and Education at the University of Toronto, co-edited a collection of essays in the book South Asian Mothering: Negotiating Culture, Family and Selfhood, out in March. She says the interest in global motherhood is natural.

“What they’re looking for is trying to figure out the best parts of other cultures,” Sangha says.

Parents in Western cultures tend to emphasize individual achievement and independence over other values, according to a team of pediatricians from Boston University Medical Center, writing in the journal Pediatrics last month.

Western parents “offer frequent praise, may favor verbal feedback over close physical contact, and promote independent behaviors,” the article says. “Children are encouraged to think critically, question the status quo, and distinguish themselves from others.”

Many other cultures — particularly Asian, African and Latino, the paper notes — put a higher value on collective achievement. They expect children to “obey authority, share their possessions, and place the needs of the family and community before their own.”

Yale Law School professor Amy Chua’s book on “traditional Chinese” or “Tiger Mom” parenting offered another cultural approach that sparked lots of controversy about proper parenting. Her website calls her book, Battle Hymn of the Tiger Mother, out in 2011, “the story of her family’s journey in two cultures.”

SEEKING ‘THE ANSWER’

Mei-Ling Hopgood has seen such cultural differences firsthand. Hopgood, 39, an associate professor of journalism at Northwestern University in Evanston, Ill., was born in Taiwan but raised in the USA. Both her daughters, ages 5 and almost 2, were born in Argentina, where she and her husband lived for seven years. Her book, How Eskimos Keep Their Babies Warm: And Other Adventures in Parenting, came out last year.

“American parents are just looking for ‘The Answer’ all the time — the best way — and they are worried the way they are doing things is the wrong way,” she says. “If you look at the way people parent in a lot of places, there’s not this anxiety about what to do right.”

“I think parents in America are looking for common-sense solutions and alternatives to the parenting style that’s taken hold among the middle-class in the United States,” says Pamela Druckerman, 43, an American mother of three living in Paris. Her book on the wisdom of French parenting, Bringing Up Bébé, was a hot topic in parenting circles last year.

“The advantage of looking at the way another culture raises kids is not some parenting theory — it’s actually looking at the place and seeing what works in practice,” she says.

Cassie Hay, 30, of Jersey City, N.J., has a 4-month-old son. Her takeaway from Druckerman’s book is “the children are children and the adults are adults, and the entire universe shouldn’t be centered around the child” — a shift she acknowledges can be “very hard” to adapt in the real world. “I was interested in seeing if this was actually feasible.”

‘IT’S ALL ON US’

Christine Gross-Loh researched parenting practices and interviewed parents from seven countries for her book Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us, out earlier this month. It looks at measures of parental well-being and happiness and academic achievement among children.

Gross-Loh — a mother of four, ages 3 to 12, in Cambridge, Mass. — says most other cultures have more of the “it takes a village” approach, but in the USA, “it’s all on us.” Parents here have much less maternity and paternity leave and less financial assistance for health care and yet face increasing expectations of sending their kids to college. Although there are more dual-income households, they face rising child care costs and the stress of juggling it all makes American parents feel overwhelmed, she says.

Parenting expert Susan Newman, a social psychologist from Metuchen, N.J., says all the concern over how other cultures parent has to be tempered by the reality all parents know.

“Much of parenting is reactionary: ‘How do I solve this problem?’ ” she says. “No single approach can work within the American culture or even within one family, because every child in that family is different.”

INTERNATIONAL PARENTING PRIMER

For her new book, Parenting Without Borders, author Christine Gross-Loh gathered childrearing lessons from around the world and shares some, organized by country.

• Finland: Despite starting academics later (age 7), shorter school days (sometimes as little as four hours), less homework and more recess than American kids, Finnish children are among the highest achievers in the world.

• Sweden: “Don’t control your kids: teach them to control themselves.” Swedish parents believe in childrearing that combines gentle guidance and lots of freedom to make responsible choices for themselves. Swedish children are among the top on measures of well-being and happiness.

• Germany: “Make sure children play.” In Germany, kindergartens (ages 3-6) are nearly all free-play based, because they strongly believe in the importance of plentiful unstructured play during the early childhood years. When Germany experimented with academic kindergarten during a wave of early-learning reform in the 1970s, they found that kids’ academic and social achievement suffered later down the line – so they reverted back to their free-play model.

• France: Parents raise their children to enjoy the benefits of good food and assiduously cultivate their patience. They believe it’s their duty to educate their children how to eat, as important as teaching a child to read.

• Japan: Japanese parents teach their children to always consider others from the time they’re babies – they cultivate this social awareness the way parents elsewhere might cultivate their child’s cognitive skills. Adults don’t hover, but “let the children work it out,” because being allowed ample practice in social interactions is what they believe to be the best way to raise kids of character who have a moral compass.

• China: Chinese parents don’t think a dose of family obligation will stifle a child. They think it will help inspire him to do well and stay on a straight path.

• Italy: “No kid’s meals.” The concept of picky eating is practically unheard of. Instead of assuming kids won’t want to be adventurous and preparing separate children’s meals for them, Italian families believe in modeling the joys of eating with others through leisurely family dinners and gatherings.

BOOKS

Despite all the parenting advice online, some experts have taken a more comprehensive look at childrearing across cultures. Among the books that offer a more global perspective:

• Parenting Without Borders: Surprising Lessons Parents Around the World Can Teach Us by Christine Gross-Loh: a mother of four, Gross-Loh lived for five years with her kids in Japan, which sparked her interest in parenting practices around the world. Her multicultural approach includes topics such as sleeping, eating, self-esteem and play.

• Bringing Up Bébé: One American Mother Discovers the Wisdom of French Parenting by Pamela Druckerman: a mother of three, Druckerman has lived in Paris since 2004 and shares her observations about the differences she’s noticed between the French approach and parenting in the USA.

• Bébé Day by Day: 100 Keys to French Parenting by Pamela Druckerman: a how-to-guide on a variety of topics with 100 rules and a discussion of parenting the French way, out this year as a follow-up.

• Battle Hymn of the Tiger Mother by Amy Chua: a mother of two, the Yale Law School professor sparked controversy with her book that championed the strict and traditional parenting methods of her Chinese immigrant parents.

• How Eskimos Keep Their Babies Warm: And Other Adventures in Parenting (from Argentina to Tanzania and everywhere in between) by Mei-Ling Hopgood: a mother of two, Hopgood was born in Taiwan and raised in the USA. Both her daughters were born in Argentina, where she and her husband lived for seven years.

• South Asian Mothering: Negotiating Culture, Family and Selfhood edited by Jasjit Sangha and Tahira Consalves: a collection of essays that explores cultural norms and values and explains perceptions and parenting practices of South Asians.

Copyright © 2013 USA TODAY, a division of Gannett Co. Inc.

Source: USA TODAY

Bombings and suspects on the loose caused a lockdown in a major metropolitan area in the Northeast; fire and explosions rocked a small town in Texas.

But despite the distance and size of each community, today’s ubiquitous video tools make it easy for everyone to share what they’ve seen. Even when told to stay away from these dangerous spots, people still can’t seem to heed the warnings, often chronicling in real time with smartphone in hand and eager to post on YouTube or Instagram.

So why do ordinary people congregate at potentially risky places? Social psychologists say don’t blame social media. Thrill-seekers aren’t new. It’s part curiosity and part sensation-seeking. But they say social media has changed the way many behave. It’s created a “participant culture,” says social psychologist Karen North, a professor of social media at the University of Southern California-Los Angeles.

“People want to say, ‘I am the person who put up that video. I created that,’ ” she says. “They get reinforced in true psychological reward-and-punishment sense when people hit ‘Like’ or ‘Share’ or ‘Comment.’ “

North says there’s a “competition motivation” as well — people compete to get close enough to take a picture or video worthy of an audience. In the past, people were more passive about the communication. Now, everyone wants to be active participants, she says.

“The tools of social media allow us to be content creators. It means we all can put our own creative products out there for other people to watch, listen to and interact with,” she says.

Social psychologist Robert Kraut of Carnegie Mellon University in Pittsburgh likens the behavior to the “emergency equivalent of rubbernecking.”

“People stop for accidents and look whether or not they’re taking videos,” he says.

Marvin Zuckerman of Philadelphia, a professor emeritus of psychology at the University of Delaware has written three books about “sensation-seeking.” He says common sense isn’t the issue here. Rather, it’s about a balance.

“Life is a balance between potential reward and risk,” he says. “Some people seem to be strong on the reward and weak on the risk side. High sensation-seekers tend to underestimate risk, and low sensation-seekers overestimate risk.”

Even though the fertilizer plant in West, Texas, was burning on Wednesday night, people headed toward the fire to capture the scene. Videos on news sites show people nearby knocked over by the force of the explosion. Some were interviewed, and their videos shown, on national television.

And, despite warnings to stay indoors during Friday’s police manhunt for Boston’s fugitive bomber, some people wandered their neighborhoods to see what was happening.

“Even when people get official warnings and alerts from authoritative sources, such as a hurricane is coming and they should evacuate, they typically mill around to try and understand more what’s going on, ” Kraut says. “They’re seeking social consensus — what the nature of the situation is and how they should respond. Before people actually take the advice, they want social validation.”

The public may also be getting a bit of a mixed message. Just a few days earlier, after the Boston Marathon bombing, officials asked for video from the public to help find suspects.

“We’ve always turned to the public. There used to be wanted posters and pictures of missing children on milk cartoons. There’s America’s Most Wanted and Amber alerts on the freeway,” North says. “They’re using the wisdom or knowledge of the masses. Put it out there and see who can solve this problem. Instead of just having detectives or investigators and eye witnesses, they throw it out to everybody. Here’s our puzzle. Help us solve it.”

Copyright © 2013 USA TODAY, a division of Gannett Co. Inc.

Source: USA TODAY

Ruth Westheimer emerged on the national scene in the 1980s, a 50ish, pint-sized (4-foot- 7) sex therapist, whose explicit advice about sexual functioning and relationships — in a heavy German accent — made her a pop-culture hit. Known simply as “Dr. Ruth,” she was everywhere on radio and television, with spots on late-night TV and the cover of People.

Dr. Ruth may not be as visible as she once was, but she still gets around, especially for someone approaching her 85th birthday: She has almost 74,000 followers on Twitter. She talks about masturbation on her own YouTube channel. She teaches a class every spring at Columbia University. She’s featured on the cable station Shalom TV. Her 39th book, Dr. Ruth’s Myths of Love, is due this fall.

There’s even a new one-act play about her life.

Becoming Dr. Ruth opens with a week of previews starting May 31 in Hartford, Conn.; the writer says he’s in discussions to get it produced off-Broadway this fall.

Aside from talking about sex, Ruth Westheimer’s life is widely unknown.

Born in Germany as Karola Ruth Siegel, she last saw her family on Jan. 5, 1939, at age 10, when she was sent, along with other Jewish children, to an orphanage in Switzerland, where she lived for six years. Then she moved to Palestine, where she was trained as a sniper in the Haganah, the forerunner of the Israel Defense Forces.

“I never killed anybody, but I know how to throw hand grenades and shoot,” Westheimer says.

Though severely wounded by shrapnel in both legs on her birthday in 1948 during the War of Independence, she recovered and moved to Paris, where she studied psychology at the Sorbonne. Her doctorate, however, is not in psychology but in education. Along the way, she married three times and had two children, all well before she became famous as Dr. Ruth.

She notes that each of her marriages played an important role in her relationship expertise, but after divorcing twice, “the third one was the real marriage,” she says. Her 1961 marriage to Fred Westheimer lasted until his death in 1997.

Maurice Tunick worked on her first radio program, Sexually Speaking, in 1980. “I like to say I knew her before she was Dr. Ruth,” he says.

“She was natural and easy to listen to,” adds Tunick, now a vice president at SiriusXm Satellite Radio in New York. Her show had no guests; he felt that “she should be the star — a one-on-one with Ruth and the listeners.”

Daughter Miriam Westheimer, 56, who works in international education in New York, says her mother’s attitude is based on thinking “You don’t know what tomorrow brings, so make every moment worthwhile.”

Such thinking inspired playwright Mark St. Germain of Pound Ridge, N.Y., to write the play about her.

“She has a heroic spirit. Everything she has gone through in her life. She had a lot of difficulties. She’s transcended them,” he says. “I’ve never met someone more positive or filled with life. And she’s always fascinated with everyone around her.”

Longtime friend Harold Koplewicz, a child and adolescent psychiatrist in New York, says that what makes her unique is her resilience.

“Ruth is the model for all of us,” he says. “Her ability to bounce back and be productive no matter the environment or her age is quite extraordinary.”

Her son, Joel Westheimer, 50, a professor of education at the University of Ottawa in Canada, says the play “captures very well a lot of the themes that define her life.”

“What the show does is reveal a side of her that’s there but wouldn’t be so close to the surface,” he says. “It captures her really accurately. The set is frighteningly real. It looks just like her apartment. I was in that apartment since I was 2 years old.”

Westheimer says losing her family at such a young age shaped her life.

“It was always in back of my mind the importance of relationships — the importance of family.”

Copyright © 2013 USA TODAY, a division of Gannett Co. Inc.