When Brent Robbins was a boy, he said, "I was an odd kid. I was a
bit of a clown." And after one of his episodes of showing off, he
recalled, "my teachers demanded my parents take me to a
Luckily, said the head of the psychology program at Point Park
University, "they happened to take me to someone who said, 'Oh, he's
a wonderful kid. He'll never quite fit in, but he's fine.' And by
the time I was in college, I was flourishing and had found my
Those experiences have made him wary of anyone today who wants to
label an eccentric child as mentally ill, and it's one of the
reasons he has become a national leader of a movement that is
raising questions about the American Psychiatric Association's
attempt to create an updated "bible" of mental disorders.
As a representative of the Society for Humanistic Psychology, Mr.
Robbins has been instrumental in drafting a critical letter to the
task force revising the Diagnostic and Statistical Manual of Mental
Disorders. The letter already has attracted more than 10,000
signatures of support, most from mental health professionals.
One of his particular concerns is a proposed new diagnosis in the
DSM-5 called attenuated psychosis syndrome, which says that those
who experience hallucinations or delusions may be at risk of later
developing a full-blown psychosis.
Some studies have shown that only about 20 percent of adolescents
who exhibit these symptoms later develop schizophrenia, though, and
Mr. Robbins worries that the inclusion of this diagnosis in the
manual could unfairly label many teens as mentally ill and put them
on a regimen of heavy-duty psychotropic drugs.
"My concern here is that a lot of people who may just be
eccentric or unusual might turn out to be wonderful, gifted people.
Imagine what Salvador Dali or Andy Warhol were like as adolescents.
Some people might have interpreted their behavior as delusional.
"I'm very concerned that you're going to have a lot of wonderful,
uniquely gifted kids who instead of being appreciated will be
labeled as dysfunctional."
It's just one of many objections that have been raised about the
DSM-5, which is going through its final revisions and is due to be
published in the spring of 2013.
The manual revision task force is being chaired by eminent UPMC
psychiatrist David Kupfer, who was not available for comment.
But other leading members of the task force stressed that none of
the DSM-5 proposals is final, and that all the major diagnoses are
being field tested for clarity and reliability.
On the attenuated psychosis syndrome, William Narrow, research
director for the DSM-5 Task Force, said that because some
adolescents who show these symptoms do go on to get full-blown
schizophrenia, "formal designation of an attenuated psychosis
syndrome in DSM would mean a greater likelihood that clinicians will
recognize the syndrome ... and be able to follow the symptoms over
time and intervene when needed."
And that intervention, Dr. Narrow stressed, might include various
kinds of talk therapy or treatment with omega-3 fatty acids rather
than drugs. "Because of potential long-term side effects, the
current practice has generally been to withhold antipsychotic
medication treatments for patients with this syndrome until a full
psychotic disorder emerges," he wrote.
The other new definition that bothers Mr. Robbins is one called
disruptive mood dysregulation disorder, or DMDD, described as
excessive temper outbursts occurring three or more times a week in
children younger than 10.
Mr. Robbins said this category serves as a substitute for the
earlier diagnosis of pediatric bipolar disorder, and he fears that
children who get the diagnosis also may be prescribed heavy-duty
"I think there are some kids and adults who absolutely need
medications," he said, "so it would be a mistake to assume we have
an anti-drug message. But realistically, if you can find any other
intervention, especially for children, you want to do it because
drugs are a double-edged sword, because every drug has side