What ends up (or doesn’t) in the DSM manual, otherwise known as the bible of psychiatry, can have a major impact on patients, doctors and, of course, Big Pharma. So, it’s no surprise that the debates and discussions around what will be included in the DSM’s fifth edition are already involved and intense, some three years before the guidebook is due to be released. —KA
The New York Times:
The eagerly awaited revisions — to be published, if adopted, in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, due in 2013 — would be the first in a decade.
For months they have been the subject of intense speculation and lobbying by advocacy groups, and some proposed changes have already been widely discussed — including folding the diagnosis of Asperger’s syndrome into a broader category, autism spectrum disorder.
But others, including a proposed alternative for bipolar disorder in many children, were unveiled on Tuesday. Experts said the recommendations, posted online at DSM5.org for public comment, could bring rapid change in several areas.
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled,” said Dr. Michael First, a professor of psychiatry at Columbia University who edited the fourth edition of the manual but is not involved in the fifth.
“And it has huge implications for stigma,” Dr. First continued, “because the more disorders you put in, the more people get labels, and the higher the risk that some get inappropriate treatment.”
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By RenZo, February 10, 2010 at 9:50 pm Link to this comment
Your comment, gerard, is insighful. The psycholinguistic lens you gazed through is an excellent metaphor for our inability to leaves things unnamed. Clearly the variety of human behavior is SO GREAT that we cannot (in spite of good linguistic skills) tame it all into submission or control. It will become easier to really “understand” atypical human behavior when we have the neurological (neurons, fissures, neurotransmitters, etc) correlates to discuss instead of the behaviors. It may be a while and in the meantime I hope the contributors to DSM-V(5) know how greatly their decisions shape human society and human lives.
Report thisBy gerard, February 10, 2010 at 4:18 pm Link to this comment
Perhaps more than any other profession, psychiatarists and psychologists have to be constantly aware of the dangers of language itself.
Report thisAn ever-present human urge is to try to name everything in life—and many major languages are organized on an either/or basis—something is one thing or another thing, one thing or not that thing, this or that—not both, plus a third of fourth thing in addition. The urge to simplify complexities.
Naming things tends to give humans a sense of power over those things—they move fron Unknown to Known. (Oh, we know what that is!) Then, through a largely unknown process and over an unknown period of time, the known becomes settled, obvious, and even tends to exclude other possibilities that might be discovered if people’s minds were not already made up.
This is a huge problem in diagnosis, obviously. There is no way to be absolutely sure in many cases. This or that? Or something else? Or both, and something in addition? Or this minus that? It’s a mare’s nest of confusion.
The best that can be said is that all doctors and those who treat human beings’ health problems need always more and more knowledge and experience, PLUS
a sensitive, keen power of on-going observation and by remembering to consider intuitive responses carefully.
Anything less will often lead to trouble. A decent respect for the unique, individual human soul is at stake in every case that sits down in the chair in front of you.
By GW=MCHammered, February 10, 2010 at 10:43 am Link to this comment
(Unregistered commenter)
Much needed revisions, agreed. Publish p-doc diagnosis vs. successful treatment rates too.
And require ALL other docs to simply read anti-depressant inserts. Far too many mis-prescribing known bipolar sufferers causing costly (and needless) mania and psychosis.
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