Jobs Blog

Psychiatrists Revising the Book of Human Troubles

The book is at least three years away from publication, but it is already stirring bitter debates over a new set of possible psychiatric disorders.
Is compulsive shopping a mental problem? Do children who continually recoil from sights and sounds suffer from sensory problems — or just need extra attention? Should a fetish be considered a mental disorder, as many now are?
Panels of psychiatrists are hashing out just such questions, and their answers — to be published in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — will have consequences for insurance reimbursement, research and individuals’ psychological identity for years to come.
The process has become such a contentious social and scientific exercise that for the first time the book’s publisher, the American Psychiatric Association, has required its contributors to sign a nondisclosure agreement.
The debate is particularly intense because the manual is both a medical guidebook and a cultural institution. It helps doctors make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment.
The manual — known by its initials and edition number, DSM-V — often organizes symptoms under an evocative name. Labels like obsessive-compulsive disorder have connotations in the wider culture and for an individual’s self-perception.
“This is not cardiology or nephrology, where the basic diseases are well known,” said Edward Shorter, a leading historian of psychiatry whose latest book, “Before Prozac,” is critical of the manual. “In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.
“What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”
Psychiatrists involved in preparing the new manual contend that it is too early to say for sure which cards will be added and which dropped.
The current edition of the manual, which was published in 2000, describes 283 disorders — about triple the number in the first edition, published in 1952.
The scientists updating the manual have been meeting in small groups focusing on categories like mood disorders and substance abuse — poring over the latest scientific studies to clarify what qualifies as a disorder and what might distinguish one disorder from another. They have much more work to do, members say, before providing recommendations to a 28-member panel that will gather in closed meetings to make the final editorial changes.
Experts say that some of the most crucial debates are likely to include gender identity, diagnoses of illness involving children, and addictions like shopping and eating.
“Many of these are going to involve huge fights, I expect,” said Dr. Michael First, a professor of psychiatry at Columbia who edited the fourth edition of the manual but is not involved in the fifth.
One example, Dr. First said, is binge eating, now in the manual’s appendix as a tentative category.
“A lot of people want that included in the manual,” Dr. First said, “and there’s some research out there, some evidence that drugs are helpful. But binge eating is also a normal behavior, and you run the risk of labeling up to 30 percent of people with a disorder they don’t really have.”
The debate over gender identity, characterized in the manual as “strong and persistent cross-gender identification,” is already burning hot among transgender people. Soon after the psychiatric association named the group of researchers working on sexual and gender identity, advocates circulated online petitions objecting to two members whose work they considered demeaning.
Transgender people are themselves divided about their place in the manual. Some transgender men and women want nothing to do with psychiatry and demand that the diagnosis be dropped. Others prefer that it remain, in some form, because a doctor’s written diagnosis is needed to obtain insurance coverage for treatment or surgery.
“The language needs to be reformed, at a minimum,” said Mara Keisling, executive director of the National Center for Transgender Equity. “Right now, the manual implies that you cannot be a happy transgender person, that you have to be a social wreck.”
Dr. Jack Drescher, a New York psychoanalyst and member of the sexual disorders work group, said that, in some ways, the gender identity debate echoed efforts to remove homosexuality from the manual in the 1970s.
After protests by gay activists provoked a scientific review, the “homosexuality” diagnosis was dropped in 1973. It was replaced by “sexual orientation disturbance” and then “ego-dystonic homosexuality” before being dropped in 1987.
“You had, in my opinion, what was a social issue, not a medical one; and, in some sense, psychiatry evolved

By: john snow

I have heard that most autoshops (paint, body, frame, etc) and insurers do NOT report damage (accident, flood, etc) to the title authorities… or to CARFAX… Other than knowing how many owners and maybe if a title changed due to a SALVAGE vehicle (which has to be listed on the title itself as Salvage) why pay for the carfax?
I am looking to find out what the advantages are - is carfax good? What am I missing?
SalLin or others - do you KNOW that insurers/shops report on damage? I have read that MOST states do NOT require this and that most companies DO NOT report… I am looking for any proof or decent suggestions that accidents and floods DO get reported on carfax…
To all, I agree, knowing how many owners is a good thing - but for the $35 - is it really worth it? The FIRE DAMAGED car - I am surprised it listed that - do you know WHO reported that info - is it listed on the carfax? GOOD FOR YOU on that one!!!! You did get your money’s worth!!!!

By: Short3Gears

A guy hit me with his truck, enough to hurt my arm, and then went on a tirade against me before I could wait for an apology. I had an officer come out and he was arrested. I’m waiting for a police report. I did go to the emergency room to get checked out. I plan to open a claim with his insurance company. The officer gave me his insurance information, but couldn’t tell me whether or not he had full coverage. Anyway, when I get the bill from the hospital I plan to open a claim, but I was wondering if I need to get a lawyer or can I just talk directly to his insurer about this. Thanks

By: afraidtoland

New York May Require Longer Coverage for Family Health Plans
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By Michael Quint

Jan. 6 (Bloomberg) — Group health insurers in New York would have to give parents the option to extend coverage to their children until age 30 under a proposal Governor David Paterson plans to introduce, state officials said.

The proposal would provide young adults “the opportunity to purchase insurance at the much more affordable family/group rate from their parents’ employers,” Paterson said in a statement.

Currently, coverage under a parent’s group plan ceases when a young person graduates from high school or college. New York, with a total population of 19.3 million, has 2.5 million people without health insurance. About 31 percent, or 775,000, of those are 19 to 29 years old, according to Jon Cohen, a senior adviser to Paterson.

The change would require legislators’ approval and will be included in Paterson’s State of the State address, scheduled for 1 p.m. tomorrow in Albany, the state capital. The state Insurance Department would oversee prices and rules for the new policies.

So are you an adult at 18 or 30?

http://www.bloomberg.com/apps/news?pid=20601213&sid=aT8brRRVFgNI&refer=home
Do Obama suppoters needs still live in their parents basement at age 30?

By: Bob

than the quote was at £20,000! so i got it out at £40,000. this works out at £18.12p per month for my insurance and my contents are only working up to £700 at the most . have i donethe wrong thing are there personal inner city insurers that would cover a smaller amount of money? am i paying to much? have i messed up my insurance. please give me info and websites, telephone numbers of cheaper insures.

By: shadow

Many insurers offer long term care insurance, but if you purchase the insurance on the private market, you must undergo medical underwriting, and many chronic conditions make you ineligible for coverage.

Some employers offer group long term care insurance, which is available to all employees, but if you don’t work for one of these employers, you’re out of luck.

Does anyone know of any professional organizations, trade groups, etc. that accept members from the general public and offer group long term care insurance?

Any other ideas how to get long term care insurance for someone with a chronic medical condition?

By: pricelin

Hi,

My wife (named driver on my car insurance policy) was involved in a minor collision on the 03.03.08 with another car on a roundabout.

The collision came about due to swamped traffic on the roundabout pushing all the cars together and our car and their’s touched each other.

My wife spoke with the driver of the other car, both agreed it was not really anyones fault and they exchanged business cards (but not insurance details).

Now, 6 months later, my wife has recieved a letter from Turnamms (Assessors partnership specialising in the recovery of uninsured losses) saying;

‘our client has notified us that their vehicle was involved in an accident with a car driven by you on 04.03.08.

Our instructions indicate that you were responsible and we must therfore look to you in settlement of our clients losses.

Please send this letter to your insurers, notifying us in addition of their details within 7 days using the tear off slip.

We would remind you that failure to supply the above information is a criminal offence under section 154 of the road traffic act 1988.’

Now apart from the cheek of giving me 7 days after a six month gap I’d really like some advice on what to do.

There was no agreed fault and I don’t know whether to just send the letter back to Turnhamms stating that fact or to do what they say and involve my insurance company?

Has anybody alse experienced something similar or in a postion to offer me advice?

Many thanks.

By: mike W

As an example, he was recently asked to comment about how health insurers make it easier to get Viagra than birth control pills, and he almost got apoplectic for twenty seconds — complete with facial contortions — as he tried to process the question and come up with an answer.

Do we really want a potential president to not be able to think quickly and react effectively when confronted with the unexpected?
My question is NOT meant to bash McCain as a way to pump up Obama. It’s a legit question about McCain.

By: The Snappy Miss Pippi Von Trapp

There’s new evidence that as Mayor Sarah Palin had a direct hand in imposing fees to pay for post-sexual assault medical exams conducted by the city to gather evidence.
http://www.cityofwasilla.com/index.aspx?page=136

Under Sarah Palin’s administration, Wasilla cut funds that had previously paid for the medical exams and began charging victims or their health insurers the $500 to $1200 fees.

Jennifer C- I’m not kidding, it’s really true. Before Sarah Palin was mayor the city had a budget set aside that would pay for it. But when she became mayor she cut that budget and allowed the city to charge rape victims for their own exams.

By: Morena Latina *I ♥ my President*

Martin D. Weiss writes: The proposal before Congress for a $700 billion mega-bailout is far too little to repair the damaged debt and derivatives markets … and, at the same time, far too much for investors and taxpayers who must put up the money.
How big is the problem, really?

In the past, Congress has repeatedly asked us for data and analysis on these issues, and we have provided it in Congressional testimony and white papers. In that same tradition, below is a partial first draft of a white paper we will be submitting on this matter:

Why the Magnitude of the Mortgage, Debt and Derivatives Crisis Overwhelms The $700 Billion Bailout Plan Now Under Discussion in Congress
(Partial First Draft of Weiss Research’s Submission
to Congress and Federal Banking Regulators)
Last week, the President, the Treasury Secretary and the Federal Reserve Chairman announced their view that Congress must get to the root of the debt crisis in America by providing a broad solution that truly puts the crisis to an end.
However, the magnitude of the crisis afflicting mortgages, other debts and derivatives clearly overwhelms the $700 billion bailout proposal currently under discussion. To better understand the magnitude of the problem …
First and foremost, we urge members of Congress to disregard data based on the list of troubled banks maintained by the Federal Deposit Insurance Corporation (FDIC).
The FDIC’s list has only 117 institutions with $78 billion in assets. But given the current proposal for a $700 billion bailout, it is clear that Administration officials tacitly recognize that the FDIC list understates the problem. There are many more financial institutions at risk or in need of assistance with their toxic paper.
How many more? We believe a more accurate count comes from our analysis of: (a) the derivative risks assumed by major banks, (b) the mortgage holdings of the largest regional banks and (c) all banks and thrifts with TheStreet.com’s financial strength rating of D+ (weak) or lower. Based on this analysis, we believe:
1,479 FDIC member banks are at risk of failure with total assets of $2.4 trillion.
In addition, 158 savings and loans are at risk with $756 billion in assets.
In sum, banks and S&Ls at risk have assets of $3.2 trillion, or over 36 times the assets of banks on the FDIC’s watch list.
These numbers alone indicate that the $700 billion contemplated for the bailout plan could be severely inadequate.
Second, Congress should seriously consider the facts in the Federal Reserve’s Second Quarter Flow of Funds Report .
In this report, released on September 18, just one day before the President announced the Administration’s $700 billion bailout proposal, the Fed estimates that the nation’s mountain of interest-bearing debts has now grown to $51 trillion.
Plus, it provides critical additional insights regarding the breadth of the debt problems facing the nation, as follows:
1. The ownership of residential mortgages is dispersed among many different sectors. There are $12.1 trillion in mortgages on single- and multi-family homes in the United States. But these are not held only by banks and S&Ls. They are spread among a wide variety of institutions and individuals, all of which could have similar claims to federal assistance.
Specifically …
2. Fannie, Freddie and GSAs are still at risk. As a first priority, the plan would have to expand the recently announced bailouts of Fannie Mae and Freddie Mac in order to properly secure the residential mortgages held by government-sponsored enterprises (GSEs) and agencies (GSAs). These now total $5.4 trillion, according to the Fed.
Plus …
3. Private sectors and local governments also own residential mortgages in substantial quantities. The bailout plan would also have to cover:
Investment banks and others that issue asset-backed securities, now holding $2.1 trillion in mortgages,
Nonbank finance companies ($426 billion),
Credit unions ($332.4 billion),
State and local governments ($159 billion),
Life insurance companies ($61.6 billion), plus …
Private pension funds, government retirement funds and households themselves.
4. Commercial mortgages are now going bad as well. The current debate seems to focus exclusively on residential mortgages. But at many regional and super-regional banks, much of the risk is currently in the commercial mortgage sector, where recent data denotes many of the same difficulties as the residential sector. To truly get to the root of the problem, Congress cannot exclude these either.
There are $2.6 trillion in commercial mortgages outstanding in the United States. As with residential mortgages, these are also dispersed widely beyond the banking sector — $644 billion held by issuers of asset-backed securities, $263 billion held by life insurers, $65 billion at nonbank finance companies and $37 billion at Real Estate Investment Trusts (REITs).
5. Mortgages are less than hal
5. Mortgages are less than half the problem. Although it is true that the current debt crisis in America originated in the mortgage market, it is not accurate to say that the root of the crisis is strictly in this one sector. Rather, the debt crisis has multiple and varied roots, with excessive risk-taking in credit cards, auto loans and virtually every other form of private-sector debt.
There are currently $14.8 trillion in mortgages in America. But beyond mortgages, there is another $20.4 trillion in consumer and corporate debt. This means that mortgages represent only 42% of the private-sector debt problem in America.
6. Local governments are a higher priority. Overlooking the debt problems of state and local governments would also be a big mistake. Indeed, given the essential nature of their services, including the pivotal role they play in homeland security, it could be argued that their credit challenges take priority over those faced by banks, S&Ls and Wall Street firms.
Currently, the Fed estimates $2.7 trillion in municipal securities outstanding, most of which have been reliant on a bond insurance system that remains on the brink of collapse.
In short, to truly get to the root of the problem as the President is requesting, Congress’ new bailout plan would have to cover a lot of ground beyond just the banking industry.
Third, we urge Congress to get a better handle on the enormous build-up of derivatives in America, beginning with a thorough review of the OCC’s Quarterly Report on Bank Trading and Derivatives Activities, First Quarter 2008.
Although derivatives were originally designed to help reduce risk, it is widely acknowledged that their volume and usage have reached such an extreme level that they have become, instead, speculative bets which greatly increase the systemic risk to financial global markets.
And although regulators have few details about these derivatives, most officials now realize they may be at the root of the panic th
officials now realize they may be at the root of the panic that began to spread throughout the global banking system in the wake of the Lehman Brothers bankruptcy on September 15.
Therefore, it should be well understood by all members of Congress that, to ward off possible renewed waves of global panic, the bailout plan would also have to address the following facts:
The notional (face value) amount of derivatives held by U.S. commercial banks is $180.3 trillion.
The credit exposure to derivatives (risk of default by trading partners) is $465 billion, up 159% from one year earlier.
U.S. banks with the greatest credit exposure to derivatives are HSBC (with $7.21 in risk per dollar of capital), JPMorgan Chase (with $4.11 in risk on the dollar), Citibank ($2.79), Bank of America ($2.15) and Wachovia ($.77).
Further, after Bank of America’s merger with Merrill Lynch, which reports $4 trillion in derivatives, and after a possible Wachovia merger with Morgan Stanley, which holds $7
Martin which holds $7.1 trillion, these exposures will likely be intensified.
Congress must go into its deliberations with its eyes open, recognizing that any bailout plan that does not include these banks and other players in the vast market for derivatives could leave a gaping hole through which financial panic can spread again.
Fourth, for all of these debts and derivatives, a bailout plan would, in normal circumstances, require (a) realistic estimates of the amount that is already delinquent or in default, and (b) a reasonable forecast of how many more are likely to go bad in a continuing recession.
However, the only estimates currently available are those reflecting actual write-downs recognized by large, global financial institutions — over $500 billion. That figure does not include the thousands of other institutions which are among the sectors we cite above. Nor does it include losses incurred but not yet properly booked — let alone losses not yet incurred.
To date, no
To date, no government agency is providing such estimates. But without them, any budgetary planning for this bailout is next to impossible. No one will know, except in retrospect, if the bailout truly removes the cancerous debts from the economic body or leaves most of them to fester and spread.
In sum, there should be no illusion that the $700 billion estimate proposed by the Administration can actually provide anything approaching a total solution to America’s current debt crisis. It could very well be just a drop in the bucket.
Too Much, Too Soon for the U.S. Government Securities Market

There should also be no illusion that the market for U.S. government securities can absorb the additional burden of a $700 billion bailout without traumatic consequences.
In its Fiscal Year 2009 Mid-Session Review, Budget of the U.S. Government , the Office of Management and Budget (OMB) projects the 2009 federal deficit will rise to $482 billion.
However, this projection was made
before the bailouts of Fannie Mae, Freddie Mac and AIG and before the White House’s $700 billion bailout proposal.
Even assuming no budget overruns beyond the $700 billion, these bailouts threaten to double or even triple the federal deficit.
The OMB seeks to minimize its $482 billion deficit projection by stating it will be only 3.3% of estimated GDP, which it deems manageable. However, after adding the cost of announced and proposed bailouts — approximately $1 trillion — the federal deficit could be between 8% and 10% of GDP.
No reasonable person could deny that such a dramatic increase in the deficit will have an equally dramatic impact on interest-rate levels. To attract investors, the U.S. Treasury will have to pay much higher rates … and these higher rates, in turn, will drive up rates on mortgages, credit cards and nearly all borrowing.
In light of these facts, we have four recommendations:
Recommendation #1. Before passing any bailout package to patch up certain sectors of the debt markets, consider the impact of massive government borrowing on all sectors of the debt markets, and on the value of the U.S. dollar.
History proves that far less dramatic increases in government borrowing have crowded out millions of private borrowers, driven up interest rates and greatly damaged the economy as a whole.
So it’s reasonable to assume that the massive increases in government borrowing required for a bailout of this magnitude would put unprecedented upward pressure on interest rates, greatly aggravate the debt crisis, sink the U.S. dollar, and cause even more damage to the economy than in the past.
To avoid these consequences, we recommend that Congress reject the Administration’s $700 billion bailout proposal and shelve any related legislation, moving forward instead with our recommendation #4 below.
Recommendation #2. If, despite the risk of causing much higher interest rates and a sharp decline in the dollar, Congress is determined to pass legislation creating a new government agency to buy up bad debts as proposed, we recommend that the new agency pay strictly fair market value for those debts, including a substantial discount that reflects their poor liquidity.
Further, it should be clearly understood that:
Due to the recent sharp declines in market values and market liquidity, many of the bad debts on the books of U.S. financial institutions are currently worth only a fraction of their face value.
When the government buys these debts at fair market value, it will still leave most of these institutions with severe losses.
Many of these institutions do not have the capital to cover their losses and will fail despite the bailout.
Recommendation #3. Congress must clearly disclose to the public that:
There are several significant risks to the financial system that the
There are several significant risks to the financial system that the government is unable to address with any new legislation, including defaults on other large debts and derivatives, which could trigger a chain reaction of corporate failures.
Whether the bailout legislation is adequate or not to stem the debt crisis and prevent financial panic, the government will need to prioritize the protection of its own credit and seek to ensure the stability of the U.S. dollar.
The private sector, in turn, will need to handle any further spread of the debt crisis largely without government financial assistance.
Recommendation #4. Rather than focusing primarily on a safety net for imprudent institutions and speculators, Congress should devote more effort to bolstering the safety nets for prudent individuals and savers. These include:
The FDIC, which insures bank depositors, but has inadequate funding and staffing to handle a large wave of bank failures.
SIPC, which supposedly covers
SIPC, which supposedly covers brokerage firm accounts, but, in practice, does not compensate investors for losses in most circumstances.
State guarantee associations, which promise to cover insurance policyholders, but which have repeatedly failed to live up to their promise when large insurers fail.
Unless Congress approaches its monumental task with enormous caution, it could produce the worst of both worlds: A failure to resolve the current debt crisis plus the creation of a new set of crises that merely spread the panic and prolong the pain.

By: rooster