A Focus On: Transforming Diagnostics: Interpreting the DSM-5
Image credit: Photo of Concise OED definition by Michele Marietta via Instagram
The recent publication of the 5th edition of the Diagnostic Statistical Manual of Mental Disorders has been a subject for much comment and controversy. The editors of the new manual initially proposed a “paradigm shift” to redefine mental illness on the basis of neuroscience. However, the evidence is too thin for radical changes, and most of the published manual resembles previous editions.
Much of the criticism of DSM-5 in the media has suggested that the new edition promotes medicalization of the human conditions, and leads to harmful diagnostic epidemics. Other critics have pointed out that a diagnostic manual needs clinical utility. However all these problems applied equally to DSM-III and DSM-IV. The real problem lies in psychiatry’s inability to define a boundary between normality and pathology, and in ideologies based on neurobiology and theories of “chemical imbalance”. These ideas dominate practice, and they are what lead to over-diagnosis and over-treatment, whatever the specifics written in any manual.
The Intelligent Clinician’s Guide to DSM-5 focuses on what is good and bad about DSM-5, guiding readers through the major controversies, while suggesting problems that could be created by some of the revisions. However its message is that the manual is not the real problem. Psychiatry will not have a valid diagnostic system until the causes of mental illness are better understood. And that will require decades of further research.
Joel Paris, M.D., Professor, Department of Psychiatry, McGill University, Canada
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