the merits and demerits of dsm-5
As anyone who cares enough about mental health diagnosis to read these pages already knows, the publication of DSM-5 has already raised an incredible outcry. Much of what's been published has been negative, some of it wildly so. Other than what one can read on the official APA websites, I've seen much less that's positive. Most of the negative stuff, I suggest, has been written by people who haven't read the entire book. That's not surprising: considering its length and at times stilted nature, getting through the entire manual is an act of either heroism or supreme foolhardiness.
Of course, I'm one of those who has read the whole book (except for portions of Section III, which isn't--yet--officially received into, well, official status. So I feel I do have some claim, even as an APA outsider, to speak about the overall merits of this weighty tomb.
First, a word about what DSM-5 is not.
It is not a finished work. Those who have labored so hard to produce it acknowledge as much. It is, like everything else in the scientific world, a work in progress. It has been renumbered (5 not V) so as to allow tweaking without requiring wholesale revision.
It wasn't rushed out. I know, that's what a lot of folks have said, but in fact, if anything, the APA dragged its collective heels for a couple of years longer that it should have in putting out this volume. Whether it should have been released at all in its present form is a matter that can be (and will be) argued, most likely until DSM-6 is released. But the present volume shows all the hallmarks of a carefully thought-out production. Of course, there are errors, but they are largely innocent and correctable.
It isn't random. Some of the changes from DSM-IV look haphazard; they're not. Mostly, they've occurred because we in North America are trying to follow the rest of the world in joining, belatedly, ICD-10. Indeed, in the fullness of time we'll be switching again, over to ICD-11 (perhaps in 2015). Stand by.
It isn't unscientific. OK, there's a certain amount of politics that's influenced the creation of this manual, just as there has been for each of its forbears. But the changes that have come about are based largely on scientific studies that have accumulated over the past dozen or more years. (However, see below.)
The people who produced DSM-5 were, I am morally certain, animated by the desire to produce the best possible product they could. I don't believe they were in the pocket of Big Pharma, and I don't believe they were trying beyond all else to trumpet their own viewpoints. But they do have bosses, just like the rest of us, and sometimes their judgment was overruled from above. Example: the personality disorders subcommittee fervently pushed the idea of a new (read hybrid categorical and dimensional) approach to diagnosis that was voted down by the APA board. So, a great deal of hard work ended up in Section III ("Let's calmly think this over, and we'll get back to you in a few years"). There it is likely to remain for a good long time.
The folks I've communicated with subsequent to publication have been enormously helpful in terms of trying to resolve issues I've raised. Mostly, the result has been to find acceptable solutions to some of the problems in the text.
OK, the writing is pretty clunky. Look, I didn't expect a book of jokes. I didn't even expect something literary. That said, there is an awful lot here that is formulaic, an obvious monument to the god of copy-and-paste. A brief example: whole pages of identical specifiers are repeated in the bipolar and depressive disorder chapters.
Another problem, beyond occasional language glitches and bits that are unclear, is that there is so much that could have been simplified in the exposition. One example will suffice: The explanations for how to code substance abuse disorders are at times almost laughably convoluted. One of the joys (I mean this) of writing my book, DSM-5 Made Easy, was figuring out how to put at times incomprehensible material into tabular form that could be readily accessed and understood.
Of course, I'm one of those who has read the whole book (except for portions of Section III, which isn't--yet--officially received into, well, official status. So I feel I do have some claim, even as an APA outsider, to speak about the overall merits of this weighty tomb.
First, a word about what DSM-5 is not.
It is not a finished work. Those who have labored so hard to produce it acknowledge as much. It is, like everything else in the scientific world, a work in progress. It has been renumbered (5 not V) so as to allow tweaking without requiring wholesale revision.
It wasn't rushed out. I know, that's what a lot of folks have said, but in fact, if anything, the APA dragged its collective heels for a couple of years longer that it should have in putting out this volume. Whether it should have been released at all in its present form is a matter that can be (and will be) argued, most likely until DSM-6 is released. But the present volume shows all the hallmarks of a carefully thought-out production. Of course, there are errors, but they are largely innocent and correctable.
It isn't random. Some of the changes from DSM-IV look haphazard; they're not. Mostly, they've occurred because we in North America are trying to follow the rest of the world in joining, belatedly, ICD-10. Indeed, in the fullness of time we'll be switching again, over to ICD-11 (perhaps in 2015). Stand by.
It isn't unscientific. OK, there's a certain amount of politics that's influenced the creation of this manual, just as there has been for each of its forbears. But the changes that have come about are based largely on scientific studies that have accumulated over the past dozen or more years. (However, see below.)
The people who produced DSM-5 were, I am morally certain, animated by the desire to produce the best possible product they could. I don't believe they were in the pocket of Big Pharma, and I don't believe they were trying beyond all else to trumpet their own viewpoints. But they do have bosses, just like the rest of us, and sometimes their judgment was overruled from above. Example: the personality disorders subcommittee fervently pushed the idea of a new (read hybrid categorical and dimensional) approach to diagnosis that was voted down by the APA board. So, a great deal of hard work ended up in Section III ("Let's calmly think this over, and we'll get back to you in a few years"). There it is likely to remain for a good long time.
The folks I've communicated with subsequent to publication have been enormously helpful in terms of trying to resolve issues I've raised. Mostly, the result has been to find acceptable solutions to some of the problems in the text.
OK, the writing is pretty clunky. Look, I didn't expect a book of jokes. I didn't even expect something literary. That said, there is an awful lot here that is formulaic, an obvious monument to the god of copy-and-paste. A brief example: whole pages of identical specifiers are repeated in the bipolar and depressive disorder chapters.
Another problem, beyond occasional language glitches and bits that are unclear, is that there is so much that could have been simplified in the exposition. One example will suffice: The explanations for how to code substance abuse disorders are at times almost laughably convoluted. One of the joys (I mean this) of writing my book, DSM-5 Made Easy, was figuring out how to put at times incomprehensible material into tabular form that could be readily accessed and understood.