There is, apparently, a heated debate surrounding the creation of the DSM-V. For those of you who didn't grow up with a copy of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in your home - it is a sort of general consensus of psychiatrists as to which different mental disorders exist and how they should be diagnosed.
It sounds relatively innocuous, until you start thinking about the fundamental questions that lie beneath. What is a mental disorder, and what is just a different way of thinking and behaving? Where is the line between legitimizing suffering and medicalizing otherness? What does mental "illness" even mean?
The DSM weighs heavily in these discussions. Clinicians, health insurance companies, and others use the DSM as a guidebook to deciding what they will recognize, treat, and pay for. The debate going on now has real impact.
The DSM has been controversial in the past. Until 1973, it listed homosexuality as a mental disorder, and it currently lists several provocative disorders, including Gender Identity Disorder, Hypoactive Sexual Desire Disorder, and Oppositional Defiant Disorder. The debate over whether or not these particular disorders should legitimately be included brings up all those fundamental questions.
The current criticisms being leveled at those compiling DSM-V (we currently use DSM-IV) fall along two major lines. First, apparently there is too much secrecy in the process. Whereas all previous revisions have been completely open, contributors to this revision had to sign a confidentiality agreement. Given that more than half of the contributors have financial ties to the pharmaceutical industry, that's a little troubling.
Secondly, the head of this revision has called for a "paradigm shift" in the way we think about mental disorders. The person who headed up the previous revision, Allen Frances, is one of the most vocal critics. He warns how in the past, reclassification of disorders such as ADD and autism created "epidemics" in the population and how with pharmaceutical pressure to create more and more disorders that can be medicated, the danger is even more great. The new version is apparently going to focus more attention on prodromal patients - i.e. people presenting with pre-clinical, more mild symptoms. I think it's great to try and catch small problems before they become big ones - we do this with physical health all the time - but like Frances I worry this is little more than a ploy to net more patients for the pharmaceuticals.
Anyway, what do you all think?
Oh geez, this has been going back and forth for years. And it's not supposed to come out until 2012, right? I'm hoping for a big overhaul of the axes system. The dimensional view of disorders would be a huge step forward.
Of course, as you've noted, 68% of the committee have reported financial ties with pharmaceutical companies. I'm not going to hold my breath for a refreshing heaven-sent rethinking of the manual.
It's odd, because I do want a paradigm shift - but I'm pretty sure they're not going to give me the particular paradigm shift I'm looking for.
re: dimensional view of disorders, Frances seems to think that it will go way over the head of clinicians and complicate things more than help them. I'm not sure what to think.
Do you know how likely it is that DSM-V will include distinctions based upon etiology? DSM-IV, of course, does not, but I gather that quite a few reformers have argued for a complete overhaul to distinguish e.g. misfiring adaptive systems versus learned behavior.