Saturday, November 9, 2013

That controversial diagnostic manual DSM-5

It has been popular in the blogosphere to critique the criteria for diagnosing mental health disorders.  Some writers criticize the whole diagnostic establishment of the American Psychiatric Association, claiming that this is an effort to push drugs and stigmatize people.  Other critics* are focused on the newest version of the APA's diagnostic manual, the DSM-5.
    I'd like to take a different approach to talking about the new diagnostic manual.  It's here.  It's what we will be using.  Let's talk about how to prevent stigma rather than saying that the manual has the power to create it.  Let's talk about how to prevent overdiagnosis and thus overmedicating rather than saying it will automatically happen. And when we get into specific controversies, let's look at the facts and details rather than just echo slogans from yet another blogger who hasn't read it.   I will address some of the main controversies head on (as I did in a post already, exerpted from material on several DSM controversies that I've written for an upcoming edition of a textbook on mental health disorders).
    I welcome comments on my take on these controversies, but we all would benefit more if you comment with a DSM-5 open in front of you rather than echoing what you've heard about what's inside its 900+ pages.  Over the summer and early fall of 2013, after teaching a college course about mental health diagnosis,  I've paged through the entire manual side by side with the previous edition of the manual, in preparation for training people about mental health diagnosis in general and for specific diagnoses.  So, we can disagree in our predictions about the impact of the new criteria, but I will make sure we base our discussion on some agreement about what the manual actually says.  I'm stunned that after 11 solid months of researching the DSM, it is very hard to find comments on the internet based on actual information rather than speculation and echoes.  So I'm putting this together myself.  I want to simply lay out the facts and get mental health clinicians back to work helping clients rather than alarming them, and getting clients and patients back work trusting clinicians (psychiatrists, clinical social workers, and other psychotherapeutic professionals) rather than fearing them and the scary blue books.

*I find it interesting that the two main critics of the new version, Allen Frances and Robert Spitzer, were the coordinators of the publication of the previous versions of the manual and began their criticisms, years before the manual were produced, based on the new DSM task force being too secretive, even though subsequent criticism of the criteria, starting years before the manual was published, were based on proposed versions made available for public comment.  Is this a case sour grapes that they weren't in charge any more? That's speculation on my part, and they know the internal politics of the process much, much better than I do. But some of the alarming pronouncements by Frances and others about the Bereavement Exclusion and DMDD and other diagnostic topics are just simply wrong, or at least disconnected with the facts except the distorted, selected, neglectful version of the facts that fit a preconceived notion.
 
      Controversy generates viewership.  I wouldn't mind readership (though I have no books to sell nor any other benefit I can think of), but I'd rather generate knowledge and agreement than alarm and controversy.  If you're interested in the same, keep visiting; I'll be hitting the major controversies and then going diagnosis by diagnosis to talk about what's new in the first change in diagnostic criteria since 1994, affecting nearly every diagnosis you'll encounter.  I hope this will be helpful.

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