Diagnostic and Statistical Manual of Mental Disorders - v.5 - May, 2013
After a long period of anticipation, input, and debate, the 'Bible' of mental health/disability diagnostic labels has been updated for the first time since 1994. DSM-5 is being widely discussed in terms of its utility, assumptions, and implications for both mental health professionals and the public ('consumers').
There has long been debate about various aspects of the DSM and its central importance (especially within the U.S. healthcare/insurance system) in terms of diagnosis and allocation of treatment services approved by the gatekeepers: insurance companies in particular. There are medical, moral, ethical, and practical concerns: Does 'evidence-based', 'best-practice' treatment follow from DSM-based diagnosis? Are we ignoring 'mental health' in favor of medicalized labeling of 'disease'? Are we as providers and consumers buying into a system emphasizing 'mental disorder' rather than 'mental health',coping skills, overall quality of life, or emotional/cognitive well-being?
Aside from issues around the validity of diagnostic categories, or the impact of 'labeling' problems of living, or behavior, or relationships as a medical 'disorder', professionals have been raising other concerns. Generally conceding that the DSM strives for 'reliability' (where there is agreement and evidence for speaking of a given entity using shared definitions and criteria), concerns about 'validity' and the potential for 'rigid' applications, are being expressed. Moreover, many feel (as the popular media is reflecting) that removal of a valuable category (Asperger's Syndrome/Disorder) is a gross disservice to children, parents, and teachers, who now see the unique issues and presentation of AS/AD as simply one spot along the autism continuum. Lost is the years of experience since Asperger's diagnostic category finally saw the light of day, and instead we will now see increased stigma and lack of access to appropriate educational support, many believe.
Leaders within the mental health professionals note that there are few other major changes, and yet at the same time the National Institute of Health has reconsidered the utility of the DSM as a basis for allocating research money. The overall movement seems directed at brain research, not 'mental illness' as experienced subjectively or treated by practitioners. Developers of the DSM have been widely cited in popular media (from television to online blogs) underscoring how the DSM is not actually meant to be a 'Bible' or treatment protocol, so much as a "dictionary" which provides a common parlance, shared vernacular, among those who suffer from, treat, or reimburse 'mental disorders'. Still we speak of disease/disorder, rather than 'problems of living', relationships, etc., until/unless it gets into the realm of a disorder, for which there are criteria and (sometimes, generally medicinal) treatments. While some are uncomfortable with the medicalization of the mind, or equating brain with thinking, feeling, doing, others continue to rely upon the DSM, and some systems of treatment reimbursement still do seem to rely on the DSM as its 'Bible'.
Never before has the DSM been so anticipated and discussed, not only by mental health professionals but across mainstream media. The changes are being debated, along with the implications, across and within professions and beyond U.S. borders as well. For the researcher or practitioner, there are myriad resources on this topic, some technical and some practical. Below is a sampling of some diverse perspectives, to serve as both introduction and starting point for discussion.
Psychiatry in Crisis! Mental Health Director Rejects Psychiatric 'Bible' and Replaces with... Nothing
Scientific American, 4 May 2013
Does DSM-5 Matter? Yes; but not for Psychiatrists
Mad in America: Science, Psychiatry and Community, 13 May 2013
The 2 articles above have been much discussed, shared, and framed according to varying perspectives, among psychiatrists, psychologists, and other mental health professionals impacted by diagnostic nomenclature and our system of reimbursement and treatment (in the U.S.)
Here is a video segment from PBS, upon the release of the long-anticipated DSM-5, which features interviews with some of the key players in the DSM-5 revision:
What DSM-5 Means for Diagnosing Mental Health Patients [Video - 8:29]
PBS NewsHour, 20 May 2013
Finally, here is a mega-resource (DxSummit.org), with many articles and interactive blogs, offering points of view ranging from humanistic to scientific, and reflecting a range of issues and perspectives, including the 'medicalizing' of life experience, 'deconstructing' the 'DSM Bible' and calls for new research and practice directions:
The Global Summit on Diagnostic Alternatives: An Online Platform for Rethinking Mental Health
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Copyright © 2013 Michael Fenichel
Last Updated: Friday, 23-Aug-2013 16:11:02 EDT