If you read last month’s Gary Greenberg article in Wired magazine about the folly of the DSM-V (“The Book of Woe – Inside the Battle to Define Mental Illness“) you may be interested in a follow-up just published in the Wired letters column.
The article covered the controversy surrounding the upcoming fifth edition of psychiatry’s billing bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM). Greenberg said, “What the battle over DSM-5 should make clear to all of us—professional and layman alike—is that psychiatric diagnosis will probably always be laden with uncertainty, that the labels doctors give us for our suffering will forever be at least as much the product of negotiations around a conference table as investigations at a lab bench.”
The follow-up in the March issue is a quote, in response to the article, from Jay S. Kwawer, director of the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology in New York, who said, “The DSM is potentially even more pernicious than Greenberg’s account. This manual has increasingly shaped patterns of reimbursement by insurers; clinicians have every incentive to fit the diagnosis to what health insurance companies will pay for. The resulting epidemiological data (incidence, prevalence, comorbidity, and so forth) are skewed by clinicians who barter their integrity in return for fee-for-service. In effect, DSM has contributed to making liars of us all.”
[Epidemiology is the study of patterns of health and illness and their associated factors in a population, from Latin epi demos, “among the people.” Comorbidity is the presence of more than one diagnosis at the same time, from Latin co—morbus, “along with—disease.”]
The scientific validity of the DSM has come under increasing attack from medical professionals and scientific experts, calling it junk science. The truth is that when we try to fit psychiatry into the definition of a true science, it fails the test. The lack of science behind the DSM gives a clear idea of why it has earned such criticism.
Click here for more information about the DSM-V.
I am deeply concerned about several proposed diagnoses and diagnostic changes and overpathologizing that may result in increased labeling, intrusion into peoples’ private lives, and justification for treatments including medication, and the flip side, justification to exculpate conduct.
Roy Aranda, Psy.D., J.D.