There has bit quite a bit of debate and speculation recently concerning the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM). As this is a bit of a new dialogue to me, I’m yet undecided as to ‘which side’ I will find myself on ethically. I will say that upon a cursory reading of the official opinions of the British Psychology Society (BPS, 2011) I find myself similarly skeptical. My immediate issues with the newest ed. of the DSM ranges from the overdiagnosed A.D.H.D. epidemic of our kindergartens to lowering the diagnostic criteria of paranoid schizophrenia. This complaint addressed in the Open Letter to the DSM-V in particular stuck with me:
There is a need for “a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with ‘normal’ experience” and the fact that strongly evidenced causal factors include “psychosocial factors such as poverty, unemployment and trauma…”
…clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand helping responses, but which do not reflect illnesses so much as normal individual variation.
And here is a great statement by Allen Frances, M.D., chair of the DSM-IV task force and outspoken skeptic of the current methods of the DSM-V process:
The really unexplainable paradox is the APA’s systematic promotion of greater diagnostic inflation at a time when we are already so obviously plagued by diagnostic inflation, fad diagnoses, and false epidemics. Unless it comes to its senses, DSM-5 will promote greater drug use exactly when we have a public health problem caused by the inappropriately loose prescription of antipsychotics, antidepressants, antianxiety agents, pain medicines, and stimulants. The paradox is that, contrary to conspiracy theorists, the DSM-5 experts are not making their risky suggestions because of financial conflict of interest or the desire to line drug company pockets. They have the best of intentions, but are terminally naïve about how their suggestions will be misused in actual everyday practice mostly by primary care physicians who do most of the inappropriate prescribing. (Psychiatric Times, October 24, 2011)
British Psychological Society. (2011) Response to the American Psychiatric Association: DSM-5
development. Retrieved from http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf
Compton, M. T. (2008). Advances in the early detection and prevention of schizophrenia.
Medscape Psychiatry & Mental Health. Retrieved from http://www.medscape.org/viewarticle/575910
Kendell, R., & Jablensky, A. (2003). Distinguishing between the validity and utility of
psychiatric diagnoses. The American Journal of Psychiatry, 160, 4-11.