Revision Of Psychiatric Encyclopedia Being Criticized By Past Authors
Brett Smith for redOrbit.com – Your Universe Online
Later this month, the American Psychiatric Association (PSYCH) will release the fifth revision of the Diagnostic and Statistical Manual of Mental Disorders, referred to as DSM-5, and the impending release has been stirring a vigorous debate within the psychological community.
Considered to be a diagnostic encyclopedia, DSM-5 marks the first revision of the manual in nearly 20 years. Its widespread use and influence can be seen in everything from government policy to casual everyday references about ℠OCD.´
“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,” psychiatrist Allen Frances, who was chairman of the previous DSM revision, told Sharon Jayson of USA Today. “There’s a tremendous amount at stake.”
A cottage industry of criticism has already sprung up around the new revision, with several authors — including Frances — releasing books deriding the manual weeks before it hits Amazon´s virtual bookshelf.
Gary Greenberg, who has written about the DSM for the past decade, told USA Today that the manual is “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.”
In addition to those who might be motivated by book sales, the National Institute of Mental Health (NIMH) research organization announced that it had concerns about the new revision and would adjust its research accordingly.
“The weakness is a lack of validity,” NIMH director Thomas Insel said in a statement. He chided the manual for its lack of “objective laboratory measures.”
“Patients with mental disorders,” Insel wrote, “deserve better.”
The head of the DSM-5 planning committee David Kupfer, responded to the NIMH statement by stating that objective measures for many disease haven´t been discovered or determined yet.
“In the absence of such major discoveries,” he said in a statement, “it is clinical experience and evidence, as well as growing empirical research, that have advanced our understanding” of disorders in the manual.
James Scully, the APA´s chief executive, defended the new revision, telling the Washington Post that the goal of DSM-5 “is to increase the accuracy in diagnoses so that we can do better care. Taking care of patients. Helping people get better.”
“Will there be changes in the future? I hope so. It´s not the word of God. It´s the best science we have currently,” he added. “This is DSM-5, it´s not DSM-The End.”
The first noteworthy attempt at creating a diagnostic manual of mental health in the United States was in 1917. Released by the APA, The Statistical Manual for the Use of Institutions for the Insane was a 40-page reader for mental hospitals trying to describe their patients. It expressed 22 varieties of “mental disease,” including 15 types of psychosis.
Symptoms of one diagnosis, Psychoses with Constitutional Psychopathic Inferiority, were described as “criminal traits, moral deficiency, tramp life, sexual perversions and various temperamental peculiarities.”
As soldiers began returning from World War II, the medical community started to rethink its approach to categorizing mental health diagnoses. In 1952, the APA decided to create a new book: the “Diagnostic And Statistical Manual: Mental Disorders.”