New Scientist Calls For End Of The DSM

I'm sure most of you are aware of what a profound mess the DSM-5 process has become, such a mess that last week the American Psychiatric Association postponed the planned release of DSM-5 by one year to 2013. Now the influential, UK-based New Scientist magazine has editorialized that the DSM has "outlived its usefulness" and in an accompanying article details the so-called civil war supposedly erupting within psychiatry over the DSM-5 process. The article doesn't add much to what readers of this site already know--the secrecy, the pharma conflicts, the opposition of editors of DSM-3 and DSM-4--but the editorial is the first formal call I've seen in the science press for the DSM to be scrapped or its process to be substantially altered.

And I've got some thoughts.

1. I'm not sure how useful the DSM ever was or is currently. It's not nearly the scientific document its proponents claim. If it were, it's not likely to have required so many revisions and its definitions of different mental disorders would be highly accurate and someone diagnosed with major depression would have major depression instead of situational grief or massive stress. And social anxiety disorder wouldn't be the epic joke that it is. And so on.

But, yes, I do agree with the editorial's global sentiment that it's bye-bye time for the DSM. I'm not sure what you'd replace it with, but the forthcoming and past DSMs have been so riddled with conflicts and outright stupidity that it's obvious big changes are needed.

2. Not that New Scientist has it all correct, for instance in referring to the DSM as the "Bible of psychiatry." The media needs to stop referring to the DSM as the Bible of psychiatry. The term is likely offensive to some Christians and is otherwise just dumb. You may not like the Bible much, but is there anything in the DSM that rivals the Sermon on the Mount? Didn't think so. So it's pretty much block-that-metaphor time. Perhaps, the DSM should be renamed "Psychiatry's Farmer's Almanac."

3. The mag is right to be alarmed by two new aspects of DSM-5: the proposed shift to disorders with dimensions and the possible inclusion of some dubious disorders as new mental and personality disorders (taken up in point 4). The dimensions thing is a bit tough to explain--especially since I've seen no draft of how they'd read--but the mag takes a shot at explaining:

"The DSM-V task force is expected to propose a series of 'dimensions' to be considered with a patient's main diagnosis. So as well as deciding whether someone has, say, bipolar disorder, doctors would determine whether they are suffering from problems such as anxiety and sleeping disturbances, and assess them on a simple scale of severity.

"This is widely seen as a first step towards a future in which psychiatric diagnosis has a more scientific base, where sprawling checklists of symptoms are replaced by sliding-scale measurements of the underlying determinants of mental health. Yet critics worry that even a limited embrace of this 'dimensional' approach is running ahead of the science. Until we understand more about the biological basis of psychiatric disease, this approach will not be helpful, they say."

In essence, this would lead to an even great softening of current disorders--and every time the DSM gods soften disorders even more people wind up diagnosed for life and slapped on poorly-researched meds.

4. There has been some true crazy talk going 'round psychiatry in recent years with talk of creating a bipolar disorder type 3 (subthreshold bipolar disorder), re-categorizing bipolar disorder as a psychotic disorder, adding bitterness as a mental disorder (oh, please), adding a disorder for homophobes (which you'd treat with what? Free tickets to a musical?) and so on. Oddly enough, the editorial and article mention none of these but latch onto the possible inclusion of Hebephilia (attraction to kids during puberty) and I'll just let you read what they've got to say there.

5. The article notes DSM-4 editor Allen Frances' gripe that DSM-5 authors are mostly academics and out of touch with real-world clinical work. That may not be 100 percent true--a lot of academics do clinical work albeit at public hospitals where they see the sickest of the sick and assume that's what everyone is like--but it would be good to see the DSM process incorporate workaday psychiatrists and, gasp, patients. After all, the DSM is supposed to serve doctors and patients, so what would be the problem with having patients on some of the DSM committees? Well, it's an idea at any rate.

6. Separately, "Shyness" author Christopher Lane has a post on his Psychology Today blog on the New Scientist's coverage and once again rightly decries the lack of transparency around DSM-5. But surely Lane realizes that this super-secretive process was put into place so there wouldn't be a repeat of the embarrassment when his book came out and revealed--via archived DSM-3 notes--what a travesty social anxiety disorder was.