A literary review of the DSM-5

Philosopher Ian Hacking, famous for analysing the effects of psychological and neuroscientific knowledge on how we understand ourselves, has reviewed the DSM-5 for the London Review of Books.

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”.

Link to ‘Lost in the Forest’ in The LRB (via @HuwTube)

5 thoughts on “A literary review of the DSM-5”

  1. Commentaries like this one never fail to anger me. I suffer from a serious mental illness. And the DSM describes it to a tee.

    I’m very grateful to the writers of the DSM, however imperfect, for giving a name and a description to what i have.

    I’ve noticed that the people who are criticizing it generally are not mental illness sufferers. Rather, they are people with an agenda. That usually has its roots well placed in a psychoanalytic school of thought.

    It’s my hope that eventually this kind of bi-partisan banter will stop. And the needs and realities of people like me will become more important. Neuroscience and psychology will blend and more effective treatment and prevention can finally take place.

    In the meantime, I will just have to put up with the various agendas, and their clever psychobabble.

    1. It’s great that a diagnosis based on the DSMhelped you out. After all that’s what it’s authors are trying to do with all their might.

      However, there are so many people that don’t fit neatly into one of the categories, that don’t have their symptoms described to a tee. Anyone that relies completely on the DSM would have to conclude that these people don’t have a mental illness, making it very hard for them to get help.

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