Of manuals and madness, the fight rolls on

ABC Radio National’s Background Briefing has a good programme on the issues and debates about the new version of the DSM that is currently being prepared and causing much flailing of handbags in the process.

The radio show is not particularly focused but touches on some contentious diagnoses and the problems with defining mental illness.

But there is one surprising part where they ask Australian psychiatrist and DSM-V committee member Gavin Andrews to respond to criticisms by ex-committee chief Robert Spitzer over the lack of openness in the process.

His answer, like an earlier response from American Psychiatric Association to their critics, is remarkable for the fact it contains a personal attack:

Well, he was the guy that wrote DSM-III, and we all owe him a considerable debt because someone had to be strong-willed and very strongly opinionated to pull that off. He’s saying, something’s going on and no-one’s telling me everything. Well, there’s no need for him to be told everything day by day. I’m sure he probably hasn’t read all those books that we’ve already published, and he certainly hasn’t written to me about the research planning conference that I ran. So I presume it’s a sense of not being on the centre of the stage, as he once sensibly and gloriously was.

Believe it or not, it actually sounds more patronising when you hear the original audio. Either these ad hominem attacks are a sign of the committee being rattled or they are evidence for exactly what the critics accuse them of, and neither is particular promising.

And if anyone thinks that the squabbling was just a bit of internal politicking, you might be interested to know that it’s featured as one of the major news stories in this week’s Nature.

However, while the DSM is often described as the psychiatric ‘bible’, it’s probably more accurate to call it the American psychiatrists’ ‘bible’.

While it’s widely used in the US and Latin America, much of the rest of the world uses the slightly less barmy (pun intended) International Classification of Diseases (ICD) from the World Health Organisation.

The danger is not so much that the DSM will become ridiculous, but that it will become irrelevant.

Link to Background Briefing on ‘Expanding mental illness’.

4 thoughts on “Of manuals and madness, the fight rolls on”

  1. In light of the current debate it is interesting to look at a comment that Allen Frances and Helen Egger made in a paper in 1999, where they argued that “we are at the epicycle stage of psychiatry where astronomy was before Copernicus and biology before Darwin. Our inelegant and complex current descriptive system will undoubtedly be replaced by … simpler, more elegant models.”

  2. I think one of the best things that could happen to psychiatry right now would be for DSM-V to come out and be so flawed that it’s no longer seen as a bible by anybody.
    The DSM was originally meant to be a tool for allowing researchers and clinicians to better understand mental illness but in fact it has become a license to not understand mental illness, rather, to just learn the DSM & learn which drugs to hand out according to the diagnosis.
    Loads of people are saying that kind of thing nowadays, but the problem is that DSM-IV is still the “gold standard”.
    If DSM-V came out, was widely mocked, and people were therefore forced to actually think about psychiatric illness again, I’d be very happy.
    So I’m genuinely hoping that the DSM-V committee continue to screw up as they currently are. It would be a tradgety if they backslid and we end up with a grudgingly accepted DSM-IV-2.0.

  3. As a licensed clinical psychologist in Spain, I should remind of the fact that DSM is also widely used around here. But as DSM is about psychopathology, it desn¬¥t come to be “owned” just by psychiatrists. Anyhow, the very rare presence of psychologists (just 1) in DSM-V Task Force, plus overpresence of industry ties, disease-model, and so on, is going to end up making us reject it as a more flawed ideological weapon than it already is. So less chance to proper communication among diverse professionals of mental health. I agree with Neuroskeptic that I find myself wishing hard they screw up (maybe weird, but definitely liberating at this point).

  4. “The danger is not so much that the DSM will become ridiculous, but that it will become irrelevant.”
    – or both.

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