Synopses & Reviews
While science should be the basis of any diagnostic system, to date, there is no knowledge on whether most conditions listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) are true diseases. In spite of all the progress that has been made in neuroscience over the last few decades, the psychiatric community is no closer to understanding the etiology and pathogenesis of mental disorders than it was fifty years ago. Thus, DSM has no choice for the foreseeable future but to continue with a provisional and pragmatic classification system based on phenomenological observation. While the establishment of biological markers must remain a long-term goal, what the DSM continues to provide is large-scale comorbidity, non-specific treatment response to psychotropic medications, failure to identify pathophysiologic underpinnings for specific diagnostic categories, and a confusing and complex genetic picture in which genetic patterns overlap with a variety of disorders, with no single genetic foundation for any of the current categories. Therefore the DSM diagnostic categories are not the discrete biological conditions they were thought to be. Criticisms of the DSMs over the past 30 years have rarely generated credible alternative classifications of psychopathology, and virtually all rivals have fallen away, as judged by clinical or research impact. The DSM prevails because it is, by historical default, the hub of the "mental health medical industrial complex (MHMIC)" which financially locks out alternatives. The MHMIC--consisting of the American Psychiatric Association, the pharmaceutical and medical device industry, the National Institute of Mental Health, and public sector/private insurance companies--converges fiscal interests to lock the description of psychopathology into a preserve-the-status-quo stance, as it is seen in the DSM-IV. This book highlights some of the practical and conceptual problems underlying DSM-5, such as its theory of mental disorders and the economic impact and clinical utility of psychiatric diagnosis. The current DSM system actively imposes conceptual handicaps on the psychiatric discipline and these unnecessarily retard the much needed progress. Also, psychiatric diagnoses are used for wide-ranging contexts in research, forensics, healthcare administration, and policy.
In 2013, the American Psychiatric Association published the 5thedition of its"Diagnostic and Statistical Manual of Mental Disorders"(DSM-5). Often referred to as the bible of psychiatry, the manual only classifies mental disorders and does not explain them or guide their treatment. While science should be the basis of any diagnostic system, to date, there is no knowledge on whether most conditions listed in the manual are true diseases. Moreover, in DSM-5 the overall definition of mental disorder is weak, failing to distinguish psychopathology from normality. In spite of all the progress that has been made in neuroscience over the last few decades, the psychiatric community is no closer to understanding the etiology and pathogenesis of mental disorders than it was fifty years ago.
In"Making the DSM-5," prominent experts delve into the debate about psychiatric nosology and examine the conceptual and pragmatic issues underlying the new manual. While retracing the historic controversy over DSM, considering the political context and economic impact of the manual, and focusing on what was revised or left unchanged in the new edition, this timely volume addresses the main concerns of the future of psychiatry and questions whether the DSM legacy can truly improve the specialty and advance its goals.
Highlighting some of the practical and conceptual problems which underly DSM-5, this timely book gathers a group of prominent experts to analyze debate about psychiatric nosology and to appraise the state of the current diagnostic system.
In 2013, the American Psychiatric Association published the 5th
About the Author
Joel Paris, MD, is Professor and Chair of the Department of Psychiatry at McGill University, and Research Associate in the Department of Psychiatry at Sir Mortimer B. Davis Jewish General Hospital. James Phillips, MD, is Associate Clinical Professor of Psychiatry at the Yale School of Medicine. He is in the private practice of general and forensic psychiatry. In the Yale department he is involved in residency training, the Hispanic Clinic, and the Global Mental Health Committee. He has a long involvement with the Association for the Advancement of Philosophy and Psychiatry, serving as Secretary and as editor of the Bulletin of AAPP.
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