Interesting take on the DSM 5

A student of mine (thanks Andrew!) pointed out this essay about the future DSM in Wired magazine. Sometime in the next 2 years the American Psychiatric Association hopes to release version 5 to replace version IV-TR. Yes, they are doing away with roman numerals.

For those of you not in the counseling world, the DSM is what professionals use to diagnose mental health disorders. The original DSM was first published in 1952 and totaled 132 pages including appendices. Version IV-TR totals a whopping 942 pages. In it’s best form, the document enables professionals to communicate to each other about the symptoms of their clients. Further, individuals with a combination of symptoms may find that diagnostic criteria helps them understand that others have similar problems and can give some hope to finding effective treatments. From an economic standpoint, receiving an axis one diagnosis enables those with insurance benefits to receive some financial assistance in their treatment.

And while this document is founded upon scientific research and years of clinical expertise, the DSM is in no way free from politics. When the DSM moved from a psychodynamic view of illness (illnesses were couched in terms of their “reactions” from problems) to a supposed atheoretical, descriptive view of illness, certain diagnostic labels were kept. In the words of Theodore Millon (said at a seminar I attended), labels such as Borderline Personality Disorder were kept because, “We’d taken everything else from the analysts and so we kept that unfortunate label so they wouldn’t feel so bad.”

So, with the above in mind, take a read of the current political controversies surrounding new diagnoses and the problems with pediatric bipolar diagnoses. If you haven’t time to read the whole article, be sure to skip to the bottom and start reading after the photo of artistic renderings of heads. Read from there to the bottom. It gives you a view of the controversy.


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4 responses to “Interesting take on the DSM 5

  1. D. Stevenson

    >>In the words of Theodore Millon (said at a seminar I attended), labels such as Borderline Personality Disorder were kept because, “We’d taken everything else from the analysts and so we kept that unfortunate label so they wouldn’t feel so bad.”<<

    The analysts are happy and the stigma continues for the persons given that diagnosis. I know a psychologist who takes a firm stance for empirical validation yet follows the historical position that people with a personality disorder can't heal (whatever "heal" means) because it is, after all, their "Personality." Meanwhile there are many who no longer meet the criteria who were formerly considered "Borderline." To be fair to this psychologist, it is not his area of expertise or a significant portion of his clientele. (Although, his clientele is largely Antisocial Personality)

    This begs the question. (wandering further away from the topic of DSM 5) Are there some things where the person cannot make truly significant change, such as antisocial personality disorder? Surely, empowered by the Holy Spirit because of Christ's work of redemption, there is hope for anyone to "heal" in so far as the problem is a matter of "software." (I consider much – not all – of the physiological as hardware)

    Put another way, is meaningful/healing change possible without Christ?

  2. Scott Knapp

    As I read the article, particularly the parts noting Robert Spitzer, MD and his role in challenging the DSM-5 development, I found it ironic that the author wrote regarding previous challenges to DSM development: “It happened in 1973, when gay psychiatrists, after years of loud protest, finally forced a reluctant APA to acknowledge that homosexuality was not and had never been an illness.” Robert Spitzer spearheaded the effort to remove homosexuality as a diagnosable disorder, primarily because it was maintained that this “condition” did not necessarily cause distress in the life of the homosexual person that rose to the definition of being “clinically significant.” Spitzer did, however, maintain that though something like homosexuality was not “mental illness,” that was not to imply that it was not “abnormal behavior” for human society. Spitzer later would go on to produce research indicating that “reparative” treatments to aid those experiencing troubling homosexual desires in the amelioration of those desires, so as to live a satisfying heterosexual lifestyle, did have some merit. In his 2003 research article, he noted that the recidivism rate of “reparative therapies” was no worse than standard treatments for other types of recognized mental illnesses, and therefore could not be declared to be by and large unsuccessful or without merit. He continued, even after the 1973 deletion, to believe that those who were bothered with unwanted homosexual urges and desires should have access to psychiatric or psychological help to address and, if possible, ameliorate those desires, so as to live a reasonably satisfying lives as either celibate or heterosexually oriented persons.

    This author, of course, has a fairly liberally-minded audience subscribing to “Wired” (which I occasionally pick up when I’m relaxing at the library and in a mood to peruse a handful of magazines for an hour or so) who would not be interested in reading about Spitzer’s later work on the topic of homosexuality; nor was it germane to the scope of the article itself. I just find it humorous that this author pronounces that the argument about whether homosexuality is “normal” or “pathological” was settled once and for all for the APA (and the counseling world at large), when the man who spearheaded that effort has since gone on to punch a few holes in the rationale. I have little doubts he’ll accomplish the same for DSM-5!

  3. I was at psyche school and observed the DSM III when homosexuality was considered a disorder. Today I am going to read The Heroic Client to get another take on what I believe is entrapment or otherwise stated – keeping your client in the dark. How can a community of people think they got it all worked out in 900 pages?

    Anyway I have another pressing issue I would like to share. Jesus did three things for the body (people in the church, not the bricks) He taught them, He healed them and He died for them. How did Jesus teach? My take according to (Bloom’s) taxonomy of learning, he did plenty higher order teaching of integration and using metaphors. He did not have a Xerox strapped to his donkey making copies for His audience and asking his assistants to hand them out and then read from a book.

    To the point. Last week my wife showed me an invite to a three session “get to know Jesus” intervention. Where they hooked me was… you can ask any question you want. So I attended. What followed produced frustration of note. Every question asked got the standard response, “that is a good question but it will be addressed in next weeks session”. The program started with three hand outs and a cross reference. The leader stuck to the handout like a fly sticking to … lets say a wall. He told his own jokes here and now and laughed as no one else did. I have experienced this kind of training numerous times so the argument that it is an isolated case and it is just his style does not get much air time in my mind.

    To conclude. The church as an agent of change, in my opinion is useless. Their intentions are noble but the pragmatic approach to teaching complex abstractions to a 2011 audience leaves me dumb struck. I think the church has not mastered the principles of adult learning and they are making a mess of producing adult learning, that is for example, changing their behaviour.

    In another church we attended for three years, the preacher preached for 60 minutes and prayed for 6 minutes. He just did not get it. And he claims to have access to the H/S.

    Do I need to apologise for sharing my heart. Thank you.

    Alex Pilz

  4. D. Stevenson

    Apologize? Not to me. Discourse is good.

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