by Joye C. Anestis, M.S.
Yesterday, in an excellent blog post chastising Senator Chuck Grassley's insensitive comment about suicide & his refusal to apologize for it, our friend Alicia at Celebrity Psychings made us aware of an interesting Time magazine article that we'd missed. Titled "Redefining Crazy: Researchers Revise the DSM," the article summarizes some talks at the recent American Psychopathological Association meeting to discuss DSM-V (read the article here). In a frustrating oversight, there is no place to comment on the article on the Time website, only an option to write a letter to the editor...so I thought we could have a discussion about it here. I am writing some of my comments about the article below. Why don't you read it & leave your comments here? The article is very short, so it shouldn't take long!
- First off, I find the title of the article to be offensive. I thought we'd evolved a little past such labeling.
- The author, John Cloud, argues that one of the main problems with the current DSM is that it doesn't address cause. This is a common critique of our current diagnostic taxonomy (see Clark, Watson, & Reynolds, 1995, for an excellent summary of the shortcomings of the DSM). But Cloud does not offer compelling evidence to support this argument. As an example, he describes an individual suffering from depression for many months as the result of job loss. My thought on this is that an external cause is not necessary for diagnosis...depression following job loss and depression following an unknown stimuli both will respond to the same treatment, & that is what matters in a diagnostic system. Furthermore, cause is not altogether ignored. For each mental illness, the DSM requires a rule-out if the symptoms are caused by drugs, alcohol, or a medical condition. Finally, I wonder if considering cause as a primary ingredient in the diagnosis of mental illness would move us away from the atheoretical goals of the modern DSMs. Because so many theories exist about the causes of mental illnesses, I fear that including cause in the DSM, at this point in time, might work against the overall purposes.
- In making the point I mentioned above, the author asserts that, in the DSM "only perfect is considered normal," and doesn't offer evidence from the DSM to back this up. This statement is not only inaccurate, but I think it's harmful. It's not helpful for consumers of mental health services to hear that, unless they're "perfect," we'll consider them mentally ill. By definition, the DSM characterizes mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (e.g., impairment in one or more important areas of functioning) or with a significanty increased risk of suffering death, pain, disability, or an important loss of freedom" (APA, 2000, p. xxxi). Thus, we are not looking to label "imperfection," we are looking to help those who are significantly impaired or distressed by their behavior/symptoms.
- My criticism of this Time article is not to say that the DSM is without flaw, as that is far from the truth. And hundreds of people are working toward creating a better system, one that's based on empirical data and not clinical lore. Cloud refers to the push make diagnoses dimensional in nature, a very popular movement within the DSM researchers. In fact, some studies have shown that some disorders might be best conceptualized as dimensions, whereas other disorders have been identified as taxa [natural, nonarbitrary categories; for just one example, see Haslam's (2003) of taxometric studies of personality disorders; for a good description of taxometrics, see Schmidt, Kotov, & Joiner (2004)]. I am excited to see what happens when it is published!
Do you agree with me? Do you have other comments? Read the article and let me know what you think about it - I am curious to hear your thoughts.
Joye Anestis is a doctoral candidate in clinical psychology at Florida State University.
Subscribe in a reader
