The new revised diagnostic bible DSM (v)

Home site http://www.dsm5.org/Pages/Default.aspx

As I frequently read the guardian I was surprised to find these two articles about the DSM (v) http://www.guardian.co.uk/society/2012/feb/09/us-mental-health-manual?newsfeed=true Psychologists fear US manual will widen mental illness diagnosis and http://www.guardian.co.uk/commentisfree/2012/feb/10/diagnostic-manual-mental-illness Do we need a diagnostic manual for mental illness?

They are essentially about the same thing. The new revised edition of the DSM the so called diagnostic bible, for Americans at least. Not a mental health professional myself I have never read nor had any contact with this particular book however as it was mentioned in two articles I thought I would take a look at what people were saying. I’m still trawling but here is what I can see so far.

The first of those articles states:

A petition condemning the new manual circulated by psychologists in the United States attracted 11,000 signatures

The second stated:

...So it's unsurprising that a proposed new edition of the American Psychiatric Association's Diagnostic and Statistical Manual (DSM), widely described as the "psychiatrists' bible", is causing much furore – but slightly more surprising that much of the dissent comes from within psychiatry

And given some of the comments about over diagnosing and the changing of criteria I can understand why it would, however what I don’t understand is that given such problems why so few people have made comment on the home webpage about the manual itself. Having visited the site it quite plainly states:

The 2nd period for submitting comments and suggestions to the web site regarding the proposed diagnostic criteria revisions, and the newly proposed organizational structure for DSM-5 took place from May 4th-July 15th. We are appreciative of your ongoing interest in contributing to this process. During our first comment period, we received over 8600 comments from you, our viewers. We encourage you to spend time on this site to investigate the myriad ways your comments helped shape some of the recent updates to the proposed diagnostic criteria. During the second comment period, we received over 2000 comments and our work groups are actively reviewing your input.

I would like to know why there aren’t 11000 comments here from the people who signed that petition? It seems to me that those who are concerned should start standing up for their principles and actually write down what their problems with the edit are so that it can be changed to something more appropriate. That said this is an ongoing process with a trail period lasting several years which should give practitioners ample time to get their complaints and suggested amendments to them.

So what will the changes mean?

Well to me probably not much but to the medical profession and American citizens quite a bit. I am not going to go through the changes as the specific changes aren’t what really interest me but more why people are up in arms. It seems from a cursory glance that there are a few things that these changes will affect

·         Inclusion of subclinical problems by expansion of categories into mental ill health diagnosis

·         Over-diagnosis of current illnesses with knock on over prescription of drugs particularly for children

·         Tick box, pigeonholing of people/ non holistic treatment resulting in poor patient care

All of which could have large knock on effects however whether these will happen is unclear. You might think my reticence to condemn these changes given the medical professions response naive and you might be right, however putting my trust in a system that is spending several years, several public consultations, a trial plus an evaluation period after this to revise the revisions, seems to me at least, a very responsible way to achieve changes that will help rather than hinder the treatment of people with mental ill health and less likely to result in the poorer care so many people seem to believe that they will cause.

As previously stated I am a British subject and therefore have no personal experience of the America system, its’ problems, stigma or prescribing practises. I have free medical care and do not have to coerce an insurance company to pay for my treatment, and from my prospective if a diagnosis will give anyone in mental distress treatment then I am all for it.

I might add that the alarming number of times I hear of prescription rather than talking therapy is eating away at my belief that the medical profession is actually doing its’ best to improve the peoples mental health. Americans in particular complain of over prescription and though I feel drug treatment plans have a place in improving patient ill health I wonder why other treatments are not being prescribed.

My guess is that a lack of scientific prove that such treatments work plus how expensive they are is limiting clinicians ability to direct patients to them however so often it is reported that kick backs from drug companies’ are the real problem. With a system that seems so indifferent to patient care then why are so many clinicians up in arms about the changes that could potentially move them further towards this end, or maybe they are not quite as bad as they are painted?

Any way more on this later.