{"id":18052,"date":"2012-01-08T00:00:49","date_gmt":"2012-01-08T05:00:49","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=18052"},"modified":"2012-01-08T07:13:34","modified_gmt":"2012-01-08T12:13:34","slug":"dsmanything","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/01\/08\/dsmanything\/","title":{"rendered":"dsmanything<\/sub>…"},"content":{"rendered":"
I just read a piece by Dr. Ronald Pies [Why Psychiatry Needs to Scrap the DSM System: An Immodest Proposal<\/font><\/a><\/strong><\/u>], a regular contributer to the Psychiatric Times. It’s a very thoughtful piece of writing about psychiatric reality and the DSM-anything:<\/div>\n
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…In truth, the entire premise underlying the DSMs is severely flawed—and many psychiatrists routinely ignore the DSM in their clinical practices. Indeed, if the DSM is psychiatry’s “Bible,” it is fair to say that a great many psychiatrists are heretics. In my view, psychiatry needs to scrap the present diagnostic system and begin afresh, with its core ethical and clinical mission firmly in mind. This means getting rid of the “One from column A, one from column B”, research-oriented, diagnostic criteria, and providing clinicians with a manual that is practical and useful.<\/p>\n

The present model of psychiatric diagnosis is useful primarily for researchers. It suits their needs for uniformity in diagnosis, by providing a set of “necessary and sufficient” signs and symptoms that define a particular disorder. These cut-and-dried criteria help ensure what researchers call “inter-rater reliability.” But this well-intentioned attempt to “carve Nature at its joints” doesn’t capture the diverse ways psychiatric illnesses actually appear in clinical settings; nor does the DSM’s penchant for pigeon-holing comport with how most psychiatrists actually “diagnose” their patients.<\/sup><\/div>\n<\/blockquote><\/div>\n

I’ve tried to be a good sport in joining in the debates about the DSM-5 Task Force’s peculiar thinking about our diagnostic system. Things like the Attenuated Psychosis Risk Syndrome, the convoluted Personality Disorder proposals, or any number of add-on diagnoses just seem bizarre to me – much ado about nothing. The big worry seems to be that the changes will lead to more medications. That’s almost comical. Psychiatrists are only paid by third party carriers for medication visits, and we’re worrying about over-medication? Go figure. <\/div>\n

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But I haven’t been entirely honest in my comments. I’ve entered the dialog about the DSM-5 because of my concern about what other<\/em> psychiatrists might do with it. In my case, I wrote off the DSM-III a long time ago, and haven’t paid much attention since until they recently seemed to have left the atmosphere with this particular version. I’m actually a pretty conscientious person, so it wasn’t sloth that sent me packing, nor was it their jettisoning of the psychodynamic formulations  in the DSM-II. I tried to talk about it here last Spring, but I hadn’t thought about it very much and frankly, I was reflexively inhibited after being around people who spoke DSM-ese for a long time, so what I said was awkward. I should have begun this way,<\/div>\n