It’s both an excellent look at what the whole DSM project has been designed to do and a cutting take on the checklist approach to diagnosis.
It’s not often that a review gives you a feeling of both a wholesome read and a guilty pleasure, but Hacking does both with this piece.
The DSM is not a representation of the nature or reality of the varieties of mental illness, and this is a far more radical criticism of it than [NIMH Director Thomas] Insel’s claim that the book lacks ‘validity’.
I am saying it is founded on a wrong appreciation of the nature of things. It remains a very useful book for other purposes. It is essential to have something like this for the bureaucratic needs of paying for treatment and assessing prevalence.
But for those purposes the changes effected from DSM-IV to DSM-5 were not worth the prodigious labour, committee meetings, fierce and sometimes acrimonious debate involved. I have no idea how much the revision cost, but it is not that much help to clinicians, and the changes do not matter much to the bureaucracies.
And trying to get it right, in revision after revision, perpetuates the long-standing idea that, in our present state of knowledge, the recognised varieties of mental illness should neatly sort themselves into tidy blocks, in the way that plants and animals do.
The old joke about a dictionary review goes “the plot wasn’t up to much but at least it explained everything as it went along”.
For the DSM it might well be “the plot wasn’t up to much and neither did it explain everything as it went along”.