Damn The DSM!


Some say it is the biggest controversy in psychiatry; even the only controversy in psychiatry.

Me, I think it is rubbish, really.  Someone ought to cut to the heart of the matter.

Every single edition of the Diagnostic and Statistical Manual of Psychiatry (Current edition is  DSM-5) has been based on the description of behavior.  Clarified with counting of behaviors.  To assign one of the diagnostic codes necessary to receive a pension takes counting how often someone has a panic attack, how many nights a week someone has trouble sleeping — things like that.

These lists of diagnostic codes are easy to both write and understand.  Government officials, insurance workers, minimally trained therapists, and pretty much anybody who can pound a computer can append one of these codes to a medical record.

Several of the public mental health service organizations of the lovely Golden State have made such diagnoses — often clearly inaccurate — and made it virtually impossible for this highly educated and woefully over-experienced practitioner ( i.e. ME) to correct errors.

An example that has come up a few times: An episode of substance abuse (a stimulant, often cocaine) is misdiagnosed as manic-depressive illness.  This diagnosis would have the advantage of keeping someone in the “capitation” number of patients followed by mental health, as opposed to substance abuse.

I found such a patient, for example, who had been free of symptoms for many years since abstaining from cocaine.  No mania, no depression, no nothing but the diagnosis carried forward as “manic-depressive illness.” They call them “RDoc” or “Research Domain Criteria.”

They were swept under the rug before the current (5th edition) of the DSM was officially accepted.

In the past it has been suggested we know enough about neurotransmitters to use them to classify mental illness.

But now, we are talking about both clinical criteria and genetic and neurophysiological factors that will be complex (and likely expensive) to measure.

The idea seems like a real attempt to reach closer to eternal truth.

It would probably take a psychiatrist to interpret this kind of multifaceted data.  But there is a shortage of psychiatrists.

More importantly, returning them to a position of actual power would change the current balance of power in public mental health clinics that all too often makes medical doctors feel less potent than the bureaucrats who seem to run them.

Unlikely.  You see actual doctors (and yes — psychiatrists are actual doctors) have become simple civil servants to be bossed around by people with no medical education.  Bean counters, in other words. “Health Care” in America today means “cost containment.”

Funded research is planned.

Scientific basis is equivocal at best, as far as I can figure.

It is worth staying tuned.

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