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 can see the unique issues and presentation of AS/AD as more than just one spot along the autism continuum. Lost are 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 professions 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 and drug treatments, not 'mental illness' as experienced subjectively or treated by practitioners atuned to evidence-based treatment. 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, and doing, many continue to rely upon the DSM, and some systems of treatment reimbursement still do seem to rely on the DSM as its 'Bible'.
August 2013 - Asynchronously Live from Honolulu - APA Convention
The revising or re-making of the revered DSM into DSM-5 has been anticipated with a wide range of concerns and passionate debate over both the categorical and diagnostic implications for both the practicing clinician and the client/patient. Some of the announced changes generated strong reactions, such as with specific disorders which had finally become recognized now being re-buried, unrecognized or consigned to a much broader 'spectrum', such as with Asperger Syndrome. Some have come away from training sessions wondering if the new conceptual framework does away with the subjective mind completely, in favor of brain chemistry, drug treatment protocols, and physician-determined 'mental' functioning, without reliance on empirical measures such as IQ tests or any input from non-physicians. Some clinicians had been looking for new gradations of compulsive and addictive disorders, including functional behavioral addictions (for example "Internet addiction") impacting overall quality of life and range of activity.
A year ago, an APA Town Hall discussion on the coming of the DSM-5 raised these concerns across several divisions and disciplines. It seemed as if dire changes were imminent, and there was a passion about inclusiveness, and consequences for treatment providers and recipients. Now it has arrived. Ridiculed and denounced broadly, the once-revered "Bible" of psychiatric diagnosis has become something else, of questionable validity, utility, and consequences. Few seem happy with the 'improvements', many remain disappointed or angry at the result,
and many have expressed dismay at the entire process, whereby a largely pharmaceutical-industry involved group developed this new creation in utter secrecy, with zero transparency or counterbalance, beyond 'listening' to the feedback during an open comment period. Many are concerned about the trend lines with regard to validity as well as the larger message given as to what constitutes 'normal' versus 'disorder'.
Today's distinguished panel of experts on healthcare and DSM contextualized the history of the DSM and the people and process used for each revision. The focus was on 'the big picture' - how the DSM has evolved (or regressed, depending on viewpoint), the implications for and of healthcare systems reliant on insurers reliant on DSM (or ICD) diagnoses, the process of the DSM 5 development. There is today a growing reaction among mental healthcare professionals.
This was a panel of very serious and passionate participants in the reaction and debate, who speak here of DSM's history, context, and implications, with poetry, passion, and 'evidence' too. A formidable discussion.
DSM-5 and the Future of Mental Health Diagnosis: Critical Responses
Joan C. Chrisler, Ph.D., Peter Kinderman, Ph.D., Philip Cushman, Ph.D., Nancy McWilliams, Ph.D., Joshua W. Clegg, Ph.D. Brent Robbins, Ph.D.
Dr. Brent Robbins welcomed the large audience and introduced the distinguished panel, highlighting the inter-disciplinary and international representation.
Dr. Joshua Clegg was the first to present, providing some historical context and perspective as he addressed the DSM within an historical context:
"Institutionalism and Expansionism in the History of the DSM".
From the early days, from William Menninger (US Army psychiatrist, and brother of Karl) through more recent revisions overseen by Robert Spitzer, most revisions were just that, evolutionary rather than revolutionary, reflecting the changes in society and the psychiatric field - for example reflecting the experiences of World War II, and the once-dominant influence of psychoanalytic/psychodynamic formulations in providing diagnostic and treatment regimens. DSM III revision (stewarded by Spitzer) was one of those which was in fact 'revolutionary', reflecting waves of change in sexual mores and stereotypes, and with widespread diminution of respect for psychiatry, 'leading to near-evisceration of psychodynamic bases' for diagnostic classification and formulation.
Two historical and social trends were identified as factors which influenced the DSM III revision. First, there was a steep increase in institutionalization, along with growing influence of military and industrial constituencies. This was reflected in the membership of the task force, unsurprising, even as President Eisenhower was warning about dangers of an unbridled 'military-industrial complex'. The war had been shaping American life post World War II. Since then, there has been less direct military influence in the DSM revisions, but a growing influence of the pharmaceutical industry, beginning with the DSM IV. Some statistics: (Pilecki, Clegg, & McKay, 2011)
DSM-IV Panel Member Associations with Pharmaceutical Companies
Among specialized panels:
- "95 (56%) had one or more financial links in the pharmaceutical industry"
- 100% of the 'Mood Disorders Work Group'
- 100% of the 'Schizophrenia and Other Psychotic Disorders Work Group'
- 81% of the 'Anxiety Disorders' work group
DSM-5 Panel Member Associations with Pharmaceutical Companies
- "Of the 29 members who appeared on the DSM-5 task-force website, 19 (66%) reported at least one association with a pharmaceutical company, with at least 114 total associations."
- "Associations with pharmaceutical companies comprised 51.8% of all reported associations."
Perhaps not so surprising (despite the extreme secrecy and lack of transparency in this DSM revision group) 66% of the DSM-5 revision committee reported financial association with pharmaceutical corporations, causing some concerns about conflict of interest and public welfare, beyond the secrecy of the panel
The second trend in DSM revision is 'expansionism'. In simple terms, more and more of daily life experience has become 'medicalized', to the point where what was normal now can be diagnosed by physicians and 'treated' (ostensibly with drugs-only, as evidence-based treatments such as therapy are basically ignored). Prior to 1918, psychiatric diagnosis was mostly limited to serious 'mental illness', and DSM-I (1952) helped formalize the use of 'mental illness' as a broadly applied term. ('Menninger wanted to increase diagnoses'.) By DSM II (1980) there were 256 Diagnostic Categories. in the first SM (1918) there were 22. 'Expansionism'. William Menninger wrote that the DSM must "place high priority on its efforts to provide the 'average' person with psychiatric information he can apply to his own problem" and felt too that "very possibly, [this] may increase the number of patients who seek help from a psychiatrist". (Menninger, 1947/1967, p.579, as cited in Houts, 2000, p.941)
Looking at the trend again, one can see that DSM I and II were 'radically different [and] reflected the times'. Now there are those who have adopted various 'conspiracy theories' to explain the trends, such as financial interest or professional trends. Some of these explanations may appeal to those who now have the benefit of hindsight, but Dr. Clegg thinks that in the end, over time, most revisions will be seen as but 'footnotes reflecting the values of a professional organization' at a given point in time.
Brent Robbins, Ph.D., President-elect of APA's Division of Humanistic Psychology was introduced, and provided an overview of some of the still-broadening reaction to DSM-5.
Open Letter to the DSM-5: History, Impact and Future Directions
Dr. Robbins began by noting the 'growing chorus of voices' reacting to both the content and process of DSM-5 revision. While DSM's Spitzer (chair of the the committee) reportedly argued against the 'non-disclosure' rule adopted by the committee, nevertheless the task force proceeded in complete secrecy, resulting in a huge 'lack of transparency' as to the workings of the DSM-5 task force. So secretive were the proceedings that it likely heightened the 'conspiracy' theories noted by Dr. Robbins in his opening remarks. Much of the first wave of reaction, in turn, was not so much about the details of the changes as about the DSM itself, particularly in light of the mysterious and secretive decision-making process. Other critics of DSM-5 include, aside from Robert Spitzer (DSM-III chair), Allen Frances (DSM-IV chair), the British Psychological Society, APA's Division 32, and 50+ other co-signing organizations.
The responses include an 'open letter to DSM-5', penned by a student member of Division 32, which has gone on to accrue over 15,000 signatures.
SEE: dsm5-reform.com for the text and several related reports. (One can still sign the petition.)
Problems with the DSM-5, summarized:
The working group, which also includes ex-APA President Frank Farley (who has a long working relationship with media) has continued to pursue the widening of discussion, not only about the specifics of the DSM but about our current systems and popular thinking about what constitutes a 'disorder' or has been empirically validated as a responsive treatment.
- The lowering of diagnostic thresholds and the great risk of triggering false-positive epidemics
- Introduction of disorder categories that risk misuse in particularly vulnerable populations,, especially children and the elderly
- Problems with the definition of mental disorder that failed to respect sociocultural variation
- A new emphasis on medico-physiological theory
- 15,000 signatures [protesting the enactment of said changes]
"The big news - suddenly the DSM is no longer 'the psychiatric Bible' so much as 'this controversial manual."
Now, after the concerns and input of outside entities was roundly ignored in the implementation of the new DSM-5 (now signified with a '5' rather than Roman Numeral, whatever that may mean), there is a new DSM-5 Response Committee, co-chaired by Drs. Peter Kinderman and Brent Robbns.
Its work is highlighted now at DSM5response.com .
Many within APA feel that 'it's up to us' to drive and sustain discussion on the basis, assumptions, evidence, and implications of this new mythical document formerly known widely as the Bible of Psychiatry, the new DSM-5. There has also been an effort to promote a collaborative international, interdisciplinary conversation, with calls for a summit to discuss "what could be a viable alternative" to this unfortunate DSM-5.
For news and information from the International Global Summit, co-chaired by Drs. Frank Farley and Jonathan Raskin, see:
Already some see a new landscape emerging from this document, where research into mental health is constrained by the 'biologically reductive approach', and treatments are based on the 'medicalization of all psychological disorders', including many everyday living experiences which have never before been labeled as 'disorders' to be treated medically/pharmaceutically.
In conclusion, "the time is right" and the need is urgent, to adopt what Dr. Kinderman has proposed a 'problem-based' approach to mental health/disorder.
Next up: Dr. Nancy McWilliams, on:
DSM's Evolving and Problematic Classification of Personality Disorders
Dr. McWilliams began with a disclaimer, clarifying that there is no underlying animosity or prejudgment of the DSM-5 panelists themselves: "Committee members are not inherently evil - despite so much entrenchment, with pharmaceutical relationships". Yet the seemingly blind allegiance to all of life's problems being drug-treatable as an end to itself, causes deep concerns with such over-medicalization of human experience. For example, "It doesn't make sense that we need to medicate normal grief." At times such reflexive medication of normal human feelings 'gets to the point of absurdity', yet the new DSM-5 does nothing to address this.
Dr. McWilliams reiterated the historical trends, how there has been a paradigm shift over the years, away from psychoanalytical foundations and towards efforts at 'making the DSM atheoretical'. Part of the impetus has been the need to make it easier for researchers to have an objective, neutral framework. For clinicians too, one might ask - say with 'narcissistic personality disorders' - how exactly does one diagnose? Using self-object dynamics as a reference to parse out symptoms? Today diagnoses are 'no longer based on internal experience'. In fact, beginning with DSM III, the trend away from subjective experience as a diagnostic factor led to its eventually becoming 'obliterated'. Still, in recent years research has clearly demonstrated some 'evidence-based' outcomes involving symptom checklists and self-report, revealing the superiority, say, of psychotherapy combined with drugs. And then some feel that 'in fighting the drug company powers, we have become co-opted' in our updated claims, in our temptation to respond for example, that 'psychotherapy has been shown to be as effective as pharmocotherapy'. Well, yes, for some 'disorders, where a symptom reduction checklist is the criteria. Of course, some would respond that this captures short-term treatment outcomes rather than experience and behavior over time. Without multiple short-term studies, or broader criteria for treatment results (and duration), we may easily fall victim to a whole level of 'category mistake', from diagnosis to treatment to outcome assessment.
We also hear, increasingly, 'the subtle argument that psychotherapy should be like research', which entails manualized treatment, explicit criteria, etc. While clinicians may protest that this is 'dumbing down the work done by therapists', the insurance companies are in fact embracing this model of 'psychotherapy as research' and psychiatric coverage has become based on short-term symptom alleviation (including drugs-only treatment, regardless of the empirical data on efficacy.). This drive to manualize and medicate and target short-term change dampens the legacy of pioneering within science; "You wouldn't have science without the Darwins..."
Another issue: What about personality disorders, traumatized children, sadists? The DSM-5 group 'listened to' the Personality Task Farce "but went to the existing 'big 5' research." We now have a document in the DSM-5 where "everybody's got everything".
[And no doubt there will be a drug for that! See this prescient video from long ago: The Drugs We Want ]
Perhaps an exaggeration, Dr. McWilliams said, but this variation on a dimensional, trait-based approach is self-perpetuating and incomplete, in a way not unlike the person who lost their keys somewhere in a parking lot, but looks only under the streetlight because that's where 'the light is good'. This approach denies the breadth of human experience and behavior. "Every person with OCD has a dirty drawer somewhere; some may have intimacy but then flee." It used to be accepted that the histrionic/'hysterical' patient was preoccupied with themes (e.g., power, sexuality) but then we experience a 'paradigm shift in the field', in terms of both diagnostic formulation and treatment. Therapy moved away from being based on relationships towards 'a menu of techniques'.
For those who still find value in psychodynamic formulations, or desire to be "a little less owned by the drug companies", a new manual has been developed to bridge the gulf between personality functioning, psychoanalytic formulations, and the DSM's bio-centric approach:
The psychodynamic diagnostic manual: An effort to compensate for the limitations of descriptive psychiatric diagnosis.
Dr. Philip Cushman presented next on the topic of...
DSM-5, PTSD, and the Politics of Betrayal
Dr. Cushman spoke passionately about the implications for treatment as well as society's notions about mental disability and its context, particularly as seen in the traumatization of soldiers, first on the battlefield, and then in the return to a society which seems unable or unwilling to address the magnitude of real tragedy, seen in the staggering numbers of veterans with PTSD, much of it untreated, much of it swept from public consciousness.
"What has been lost for all of us as therapists, is compassion!"
"There is much to be concerned about, much to criticize," Dr. Cushman began, starting with the revision process itself, shrouded in utter secrecy and lack of transparency. More worrisome is 'the premise that emotional suffering ... [now] becomes a medical disorder." In his paper (cited within his presentation title), he focused on the incidence and treatment (or not) of PTSD, especially in the military. "We need to factor in the social, and shared suffering..." As illuminated by a classic 1981 paper,
it has been well established that countless soldiers have 'struggled desperately to understand, and to forgive themselves'. Dr. Cushman has been shocked, in turn, by society's reaction, a seeming dissociation from the phenomenon. While "too much to bear in silence... society did not want to understand or react to the war", with the conspiracy of silence and lack of response such that many veterans experienced a profound sense of betrayal. Is their suffering not real? "Nightmares, flashbacks, crazy-talk, violence, suicide... these are symptoms!" One might reasonably conclude that in fact the 'real enemy' of veterans is "the military-industrial-educational complex - patch them up and send them back." It's not only the war experience on the battlefield, but often 'the present is part of the suffering'.
Cynically stated perhaps, for some "the genius of DSM was changing repugnance of war into 'symptoms'." At the same time, " dissidence became pathology." Full circle. There has been a systematic refusal 'to fully contextualize our soldiers' suffering'. But how does one de-politicize the main issue: war itself? "By medicalizing it; We can avoid facing what our country is doing to young soldiers."
Citing Harry Stax Sullivan, Cushman concluded by emphasizing that 'Decontextualized psychotherapy is unethical psychotherapy' For this statement, a long ovation followed.
Humane Alternative to Psychiatric Diagnosis and a Sound Foundation for Effective Care
Dr. Peter Kinderman addressed real-world implications for humane treatment, injecting passion as well as humor, from a personal and professional perspective - his normal context being within the U.K. and its much-beloved National Health Service. He expressed near-disbelief at just how bad the trend would seem to be, based on the new DSM-5, and beyond that, at the puzzling aversion in the U.S. to anything resembling 'universal healthcare'. He poignantly described how the UK's NHS has saved the lives of family members, but did so with very expensive treatments, timely and without any need for [private insurance company] insurance. In fact, Dr. Kinderman finds it "shocking" that in the U.S. wholly 40% of the population lacks access to healthcare services. Add to this what he observes as the DSM-5's contribution to 'the creeping medicalization of everyday life' and it would appear that the American psychiatric model is rather ludicrous.
Dr. Kinderman shared a quote from 1854, about the line between sanity and insanity, and how any definition can be torn to shreds. And... "If we are all mad, who is to keep the keys to the asylum?" Perhaps the framers of the DSM-5? It's like 'shredding a cat, in practice and outcome too: "Until the box is opened you don't whether you're mentally ill or criminal." Fast forward to today, and 'until the doors of DSM are opened, you don't know if you're mentally ill or not'. With all the huge money and more invested in the 'psychiatric Bible', what we've seen is the number of categories going up and up, and the reliability of each diagnosis going down and down. Each 'new, improved' version shows significant drops in reliability. For whom does the latest transformation provide 'value'? ("I am genuinely concerned about the use of iPhone DSM-5 apps!" He smiles and mindful of being surrounded by app-lovers, adds: "I tend to make people angry.")
With that in mind, Dr. Kinderman used his own self-appraisal to illustrate how his normal daily life might be proof, based on the symptoms of DSM-5's various nebulous categories, that he is a a sufferer of 'Kinderman syndrome'. Delving still further into the absurdity of such a guiding document, he added that surely Kinderman Syndrome is quite a serious disorder, which might be presented as such, in an equally serious venue, say Fox News. (Huge applause) Continuing with his observations about the ridiculousness of the DSM-5 utility, he described its reliance on 'circular pseudo arguments' such as we typically see in schools and consultation rooms. The person is distractible in class, therefore has ADD. How do we know he has ADD? He is distractible in class.... Q.E.D.
Ronald Pies, Kinderman recalled, had stated that the diagnostic categories are 'heterogenous'. Yet perhaps he overlooks the difference between 'valid' distinctions and the meaning of 'heterogeneous', i.e., nothing in common. Dr. Kinderman said he could - and briefly did - go on about the many ways that this document enshrines is like 'Jumping the shark', though some aspects are so ludicrous it seems more like Ground Hog Day, deja vu all over and over again.
[You can read Dr. Pies' response to the flood of criticism on this point, here.]
Of course, it may come naturally to many psychologists to question things like reliability, validity, and treatment implications. "Psychologists in particular are rather good at operationalizing" and developing definitions. (Sociologists as well.) Overall, the profession has much to bring to the discussion, welcomed or not. "We need more confidence in our skills! The position in the U.S., I really don't understand."
The next and final speaker was Dr. Joan Chrisler, who picked right up where Dr. Kinderman left off, in terms of pointing out some of the history, folly, and harm associated with the world according to DSM. Her focus is on
Gender Sterotypes and Mental Illness.
Broverman et. al (1970) illuminated decades ago how the psychiatric nomenclature reflected a double standard as to 'what is healthy behavior', among men and women. Research by Landrine (1988) found that in their Sample depressed people were perceived as feminine, while 'normal' people were seen as masculine. "The more severe the depression, the more likely to be described as a married woman." In 1989 a study by Landrine found that aspects of gender and social class were associated with descriptions of personality disorder.
The DSM-IV and now 5 have sought to appear gender-neutral, adopting such techniques as changing language to 'he or she'. "Who are they kidding?" While the development of the latest DSM was anything but 'transparent', long-time stereotypes and bias are still glaring, even if hidden behind more neutral pronouns. One can dissect any number of 'disorders' and quickly see underlying assumptions which are anything but gender-neutral. A list begins. Dependent personality disorder is diagnosed for someone who "goes to excessive lenghts to obtain support; volunteers for unpleasant duties... [like changing diapers?] ... feels uncomfortable/helpless when alone... when a relationship ends, urgently seeks another...."' And Body Dysmorphic Disorder - this is expertly diagnosed by presence of such symptoms as "preoccupation with perceived defects or flaws that appear slight to others", "repetitive behaviors (e.g., mirror checking excessive grooming, reassurance seeking)..." and "not explained by 'body fat' or eating disorder'..."
There have been a number of poignant satires (or exposes) on how some of these categories seem to work, and what might emerge if gender-based stereotypes were recognized, or equally applied. How about 'independent personality disorder', or the alternative flip side, where one 'passively allows others to take roles'? Symptoms might include, "puts work/career above relationships (e.g., travels a lot, works late at night and an weekends." And what about context? Histrionic Personality Disorder, for example, has as one key feature, or "uses physical appearance to draw attention to self". Yet we live in a culture that teaches little girls to be seductive and be tuned to appearance." [As for "suggestible, easily influenced", just try to count the nunmbers who manifest this through 'following' every tweet and like and recommendation of friends on Facebook! Is that a symptom?]
More ideas for still un-named 'disorders' were offered, some clearly satire, some perhaps not. How about 'restricted personality disorder'?
Is it a treatable disorder? Or... 'Delusional Dominating Disorder? This is diagnosed based on the symptomatic belief that women like to suffer, and men can't control their sexual needs or their violent behavior. Symptoms include "difficulty responding empathically to the feelings and needs of close associates" and "excessive need to inflate one's own iportance". This last 'disorder' suggestion was actually submitted to the closed-door DSM-5 committee, who in turn, so it appeared, 'pretended to consider it'. And then there might be room still for 'body dysmorphic disorder', which, according to some research (Nash & Chrisler, 1997), men can now share with women. Specific to women there is now 'premenstrual dysphoric disorder', ostensibly a more enlightened version of 'PMS', but... Dr. Chrisler finds it particularly objectionable how subjective the criteria seem, with the insertion of the word 'marked', as in 'marked behavior changes'. In what time frame? "Are we exactly the same every day? No changes in normal life?" At what point do normal biological processes merit being called a psychiatric disorder? Statistics show that most women report some experience of 'PMS'. Normal. (There is a footnote in the DSM-5 which notes that the prevalence of PMDD is 1.8 - 5.8%, and that it is not culture bound.)
- Limited expression of emotion (e.g., does not cry at sad moments)
- Constant appearance of self-assurance
- Under-reaction to major events (e.g., stoic)
- Chooses physical or intellectual activities over emotional experiences
- Engages in subject changing, silence, annoyance, or leave taking if others express feelings
- Resistance to answering others emotional needs (e.g., forgets, falls asleeop, claims other pressing duties)
A number of studies have shown how the language describing the symptoms influences the attribution of gender. The Nash & Chrisler (1997) study for example, invented a 'disorder' symptom checklist similar to PMDD but changing the word 'menstrual' to 'episodic'. Now, suddenly, men had it too. Time was running out, but a few last hypothetical disorders were shared, such as Paula Kaplan's 'delusional dominating disorder' and similarly clever examples of how the diagnostic exercise is clearly shaped by language and gender, in addition to the other factors mentioned by the panel.
In closing, Dr. Chrisler asked whether in today's DSM-centric notion of disorder, and given the research and an objective look at gender stereotypes, according to DSM-5,
- Are women who worry about how they look 'crazy', or is our superficial culture and appearance-focused society 'crazy'?
- Are well socialized women (and men?) 'crazy'?
Time was up, but in the few minutes remaining, there was a brief Q & A
Q: I'm wondering about the differences between the UK and US, the ICD 10 vs. the DSM-5?
A: [Kinderman/UK] - Look, the UK is just a big rock in the pond. But it's difficult to ignore [the ApA and DSM]. Yes, it's compatible with ICD-10. So what on earth was the point of producing a $25 Million document and then making it compatible with ICD, which is free?
Q: Thank you for looking at the big picture here. I know some are unhappy with particular changes, to things such as Asperger's Disorder especially, and at a recent APA training in the DSM-5, some got the message that no longer is cognitive functioning something to be assessed empirically, but instead the clock is being turned back 100 years to a physician simply declaring someone 'mentally defective'. Does IQ no longer matter, or thinking? This was a major piece of psychology's history and reason for being. Is mental retardation now a simple medical disorder? Is IQ irrelevant?
A: Good question, but this isn't really new. [Mental retardation requirements extend beyond the DSM, for example.]
Q: Is this the royal road to 'electro-shock psychotherapy'?
A: Perhaps the end of psychotherapy?
Q: Does this reflect HIPAA in some way?
A: All these concerns serve as obstacles to getting treatment... It's just so much better in the UK! In the US there is this mentality of healthcare as a commercial product!
REACTIONS IN THE MEDIA:
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:
DSM-5 Development: Implementation and Support
Website of the American Psychiatric Association, "to serve as a resource for clinicians, researchers, insurers, and patients".
The Global Summit on Diagnostic Alternatives: An Online Platform for Rethinking Mental Health
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Last Updated: Saturday, 26-Jul-2014 02:14:33 EDT