From Psychiatry Letter: “A decade ago, the fifth revision of DSM (the Diagnostic and Statistical Manual) was published by the American Psychiatric Association. This diagnostic system has been called the ‘Bible’ of psychiatry. The metaphor suggests some cultural realities. It tends to be worshipped; some view it as the literal truth; it can inspire, but it can be used to suppress dissent. The problem is that DSM can’t be a Bible and science at the same time.
In this article, I examine what the DSM system is and what it isn’t. The brief summary is that it has become more like a religion, and less and less scientific.
The origins of DSM go back to the first edition in 1952, and the second edition in 1968, but those earlier versions had little impact on the US profession, much less the world. This lack of impact mainly had to do with the fact that American psychiatry mostly was psychoanalytic in orientation. In psychoanalysis, little importance was given to diagnosis, unlike the medical tradition. Diagnoses were ‘labels,’ mere shorthand categories for communication. They weren’t ‘real’ and they didn’t represent ‘diseases.’ All psychopathology was about unconscious emotional conflicts, mainly dating to childhood; if the conflicts were normal or mild, they produced ‘neuroses’; if they were severe, they produced ‘psychoses.’ That was the extent of psychoanalytic nosology.
The American Psychiatric Association (APA) organized the first two editions of DSM mainly for administrative purposes. Those who ran mental hospitals needed to label the reasons patients were treated. Since psychoanalytic theory mostly ignored diagnostic labels, DSM terms often were taken from the alternative medical approach to psychiatry, popular in parts of Europe, and associated especially with the research of Emil Kraepelin (circa 1900), and other German and French psychiatrists dating back to Philippe Pinel (circa 1800) . . .
The Bottom Line
- DSM is a social construction, based on ‘pragmatism’ much more so than science.
- Use DSM administratively, not for best clinical practice.”
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