The Diagnosis Of Mental Illness Needs Its Own Therapy

Friday, July 12, 2013 SPORK! 0 Comments

Three books examine the painful birth of the latest version of the Diagnostic and Statistical Manual of Mental Disorders – and the flaws behind it

FEW acronyms have gained such traction in such a short time as DSM, theDiagnostic and Statistical Manual of Mental Disorders used by psychiatrists to diagnose mental illnesses. This is largely because a task force, appointed by the American Psychiatric Association (APA) to update it, steered a course that hit virtually every rock it passed. It remains to be seen if DSM-5, the new version of the manual, will sink from the multiple impacts.

The APA could always have expected trouble from some quarters as criticism mounted over the manual's symptom-based approach and the association's close relationship with big pharma. But what actually happened was extraordinary. Even before the manual's launch in May, there was a very public falling out with the US National Institute of Mental Health (NIMH), and with Allen Frances, chairman of the group that produced the previous version,DSM-IV.

How on earth did we get here? There now seems to be a small industry in books detailing the failings of the DSM and psychiatry. I've picked two books because they do that job well – and one that is fascinatingly old-fashioned about a key area. Let's start with Frances's version of events, Saving Normal, and with psychotherapist Gary Greenberg's The Book of Woe, which documents the trials and tribulations involved.

According to Frances, the first problem is that nothing much has changed: the chapters have been reordered, much like rearranging deck chairs on the Titanic. The second problem is that while DSM-5 has not really expanded its remit, it also hasn't retrenched much: it still boasts a mind-boggling number of disorders.

Then there is the issue of US-centrism. Why spend $200 for what is essentially a US system, asks Frances. The World Health Organization's International Classification of Diseases (ICD) covers psychiatry and is used for analysis and payments in the US. A revision of it is expected in 2015.

This article appeared in print under the headline "In a bad place..."

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