The DSM has responded to these debates in its definitions of mental disorders. For example, the DSM-III emphasizes that clinicians should not misclassify or label a cultural expression of distress or political deviance as a disease (American Psychiatric Association, 1980). Subsequent editions of the DSM have emphasized that the boundaries of mental disorders are blurred (Table 1) (American Psychiatric Association, 2000, 2013). Moreover, there is also the risk that we will be distracted from other types of critical debate if we focus primarily on the nature of Frances` critique, i.e. whether certain categories of diagnoses are valid or reliable. In particular, we could usefully examine whether scientists and other DSM commentators could broaden their arguments about whether the diagnostic entities contained in the DSM are “good” or “bad” – or even “good” or “bad” – and think more broadly about the types of rights and obligations that allow and limit different diagnoses and diagnostic tools.5 35 , 36 By this I mean, for example, the question: where and how diagnoses are used to facilitate or exclude people from access to certain services and benefits, and how they are used in the actual design of services. This perspective recognizes the extent to which diagnostic practices are constitutive for psychiatry, psychology and care, while reminding us that psychiatrists may view them in antagonistic ways or as a kind of “practical fiction” to enable communication, collaboration, and care.34 A renewed focus on the uses for which diagnostic categories are used – and a broadening of public discourse to include voices, that are less rarely heard – could provide a more practice-oriented and potentially patient-centred basis for normative statements about the design and delivery of mental health systems. The fifth edition of the American Psychiatric Association`s (APA) diagnostic manual, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), was published in the spring of 2013. However, this is not the first time readers have encountered a lot of content. For several years, the DSM-5 substance has been sprayed and discussed, published online for review and comment, and subjected to many challenges and criticisms. I examine some of these critical remarks here. It is not my intention to dive into an already crowded field of debate and continue to populate it. Rather, I would like to stress the importance of a “sociology of criticism”; That is, an examination and analysis of the types of critical engagements that are evident in the discourse with a particular domain, and attention to who makes them, how, why and with what implications.
This involves revealing certain assumptions and broader debates associated with the various criticisms of the DSM-5. The emphasis on criticism implicitly repeats a useful sociological point: there is no “point of view” within the psychiatric profession regarding the DSM with which all clinicians necessarily and smoothly align. The DSM-5, released in May 2013, represented another radical shift in the mindset of the community. Diagnostics have been changed, removed or added, and the organizational structure has been fundamentally revised. Schock, K., Clay, C., & Cipani, E. (1998). Understanding schizophrenic symptoms: Delusional statements and behaviours can be functional. Journal of Behavioral Therapy and Experimental Psychiatry, 29, 131-141. Although its roots date back to the late 19th century, standardization of the classification of mental illness prevailed in the years immediately following the Second World War. The U.S. Department of Veterans Affairs (then known as the Veterans Administration or VA) needed a way to diagnose and treat returning military personnel with various mental health issues.
Currently in its fifth edition (DSM-5), the Diagnostic and Statistical Manual (DSM) is sometimes called the bible of psychiatry. Inside the coverages are specific diagnostic criteria for mental disorders, as well as a set of codes that allow therapists to easily summarize often complex conditions for clinical research and insurance purposes. News media and other types of online commentary have circulated around already active groups and actors who have made solid comments about the DSM in the past (see in particular the many posts and links to/from journalist Robert Whittaker`s website – www.madinamerica.com – which is an important umbrella page for critical debates in psychiatry). In the media itself, however, criticism at the forefront often came from already prominent clinicians and scientists, as well as from third sector organisations with a significant public presence (e.g. mental health charity, Mind). Contributions from small support groups, individual activists and patients are less visible. This shouldn`t necessarily surprise us – and what`s more, there are instances of media coverage that place debates about the DSM in a broader clinical and social context (take, for example, the extensive coverage of the DSM that can be found on The Guardian newspaper`s websites). However, we might wonder whether the inclusion of non-clinical voices and perspectives would have occurred if leading psychiatrists like Allen Frances had not questioned the tools of their own profession. The question of the value-laden nature of the definition of disorders has received much attention in the philosophical literature (Fulford, 1989; Sadler, 2005; Bolton, 2008). We propose to recognize in criterion J that values influence nosological decisions and to clarify that the potential benefits should outweigh the potential harms when it comes to including a psychiatric disorder in the nomenclature or removing a psychiatric disorder from it. With respect to the term “increased risk”, it is important to consider risk factors and perhaps even treat them (in fact, the full title of ICD-10 is “International Classification of Diseases and Health Problems”, the latter term including risk factors for diseases such as hypertension); perhaps the DSM-V should consider a similar extension of its title. A full review of this topic would be beyond the scope of this editorial; The diagnosis and treatment of risk factors for psychiatric disorders is therefore controversial, in which the pros and cons must be carefully weighed.
At the same time, we would like to stress that disorders and risk factors should not be mixed. The term “loss of freedom” can be derived from the concept of disability, i.e. disability involves one or more losses of freedom (Wakefield, 1992). We therefore cautiously propose to simplify this test by omitting the wording on risk and loss of freedom for the sake of clarity. However, we recognize that limiting classification to the exclusive treatment of interference may well be overly restrictive. American Psychiatric Association. (2000). Diagnostisches und statistisches Handbuch psychischer Störungen (4th ed.). Washington, DC: Author. Cipani, E. (2014).
Comorbidity in DSM Mental Disorders in Childhood: A Functional Perspective. Research on the Practice of Social Work, 24, 78-85. These points have been repeated by Frances on a number of platforms, including media interviews, a blog for the American magazine Psychology Today, academic articles, and two books.20,21 The fact that they found a home in general readers` forums such as Psychology Today may indicate some resonance between Frances` position and broader public opinion regarding the medicalization of various types of experiments. which are recognized by many as “normal”. Social scientists Allan V Horwitz and Jerome C. However, Wakefield argues persuasively that U.S. citizens are increasingly accepting drugs for DSM disorders (indicating at least some public acceptance of their legitimacy).22 This speaks to the complex relationships that a variety of actors have with the DSM. and highlights the diversity of positions that can be expressed with regard to DM in the technical and public debate. This method offers a number of advantages, such as the standardization of diagnoses between different treatment providers.
But increasingly, psychiatrists are pondering the drawbacks of the DSM, including the possibility of overdiagnosis. To understand the debate, we must first understand what the DSM is and what it is not.