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Psychiatrists Are About to Shift the Boundaries between Sane and Insane

The views expressed are those of the author and are not necessarily those of Scientific American.


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We will soon find ourselves plagued by new forms of distress. No, it’s not the economy. It’s not that we are all becoming socially isolated because of Facebook (though it’s possible we are). Rather, doctors are about to redefine what it means to be mentally ill.

With each iteration of this diagnostic bible, our definition of mental illness changes. Courtesy of Ferris Jabr.

A select clique of psychiatrists has been at work for years on the latest version of the official manual of mental illness, the Diagnostic and Statistical Manual of Mental Disorders (DSM). In 2000, they came out with a revised fourth edition of this compendium of psychiatric problems, the DSM-IV. Now, they are toiling away on DSM-5 (dispensing, for one, with those pesky Roman numerals). In the May/June issue of Scientific American Mind, Scientific American’s Ferris Jabr documents some of the biggest proposed changes in this edition-in-progress, slated for publication in 2013 (see “Psychiatry’s ‘Bible’ Gets an Overhaul”). Already, the DSM’s framers have backtracked on some of their original proposals, but most of the elements behind this significant reworking of the DSM remain in effect.

Many, if not most, of these features remain highly controversial. So in conjunction with the publication of the feature article in Mind, Ferris and I have written and commissioned a series of four blogs discussing some of the most hotly debated features of this new DSM. The first, penned by Ferris, will appear tomorrow, followed by one blog each day published here, on Streams of Consciousness, for the remainder of the week. Here’s a quick rundown of what to expect.

  • Tuesday: Ferris Jabr explains why science has so far played only a bit part in the creation of the new DSM.
  • Wednesday: Edward Shorter, a historian of psychiatry at the University of Toronto, argues that the principal diagnoses of the DSM—depression, schizophrenia and bipolar disorder—are artifacts and should essentially be discarded.
  • Thursday: I reflect on why mixed depression/anxiety could be real, despite concerns that everyone might have it.
  • Friday: Allen Frances, the chief framer of the DSM-IV, tells us why we lack biological tests for mental illness and how that deficiency hurts diagnosis.

The process of defining mental disorders is a serious undertaking. People with true psychiatric problems need help, often urgently. But this DSM business also makes me think about thinking and feeling in new ways and to wonder how we draw the line between normal and abnormal mental functioning. So, over the course of this week, let’s contemplate what it means to be sane. And hey, if you figure it out, let the committees—and me—know.

Ingrid Wickelgren About the Author: Ingrid Wickelgren is an editor at Scientific American Mind, but this is her personal blog at which, at random intervals, she shares the latest reports, hearsay and speculation on the mind, brain and behavior. Follow on Twitter @iwickelgren.

The views expressed are those of the author and are not necessarily those of Scientific American.





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  1. 1. LabPsico 11:06 am 05/7/2012

    Those two people mentioned here, E.Shorter & A. Frances, are like beautiful diamonds where is all shine but very hard to change. There are new methodologies, like the EEG/qEEG and the DSI, and others, which can show, very clearly, states like depression, bipolar, schizophrenia and other mental conditions. But, one needs a new kind of training and knowledge in order to handle these new methodologies and understanding. The traditional biological school cannot show these and other mental states, like PTSD, ADHD and so on, because these are NOT biological problems but rather they derive from the way the brain communicates within itself, that is they are related to work like O. Sporns and P. Hagmann (S.A., 304, p.45). So gentleman, please get an “upgrade” because the “system” you are using is out of date.

    Link to this
  2. 2. ironjustice 11:48 am 05/7/2012

    Quote: People with true psychiatric problems need help, often urgently

    Answer: Treated effectively with Seconal. Dr. Hoffer , father of Orthomolecular Psychiatry, believed anything psychiatrists do can and should be done by any medical GP.
    He believed psychiatrists were ‘created’ because regular GP’s didn’t have places to treat some of their more extreme mental patients. This has resulted in a “select clique of psychiatrists” in effect making laws to imprison you and me for indefinate periods of time for “mental illness” of which “religious fanatism” will be considered ?
    One medical license , one vote , for EVERY doctor who holds a license.
    NOT a “select clique of psychiatrists”.

    Link to this
  3. 3. cacummings 12:56 pm 05/7/2012

    Agree with LabPsico, would love to see something by Olaf Sporns or Kenneth Kendler that is more forward looking than what we can expect from DSM-5.

    Link to this
  4. 4. peter1951 3:49 pm 05/8/2012

    Hi Ingrid,

    Please don’t be insulted but could you fix your thumbnail photo? It doesn’t shrink well…Have you seen it in an Outlook email? The aspect ratio (I think) is wrong…

    Best intentions,
    Pete

    Link to this
  5. 5. JTGILLICK 5:24 pm 05/8/2012

    “A select clique of psychiatrists”

    “CLIQUE”?

    that is your idea of legitimate description of the committee that worked on the new iteration of the DSM?

    Let me ask you – would you casually desctibe an NSF comittee as a “a select clique of scientists’? The Institute for Advanced studies as “a select clique of thinkers”? Or perhas the mainenace staff at the offices of SCIENTIFIC AMERICAN as “a select clique of custodial engineers”?

    I find it difficult to conceive that you don’t grasp the long-established connotations of “clique” and the uses of loaded terms; do you grasp what they say about the user and the user’s agenda?

    Link to this
  6. 6. ironjustice 5:56 pm 05/8/2012

    Quote: do you grasp what they say about the user and the user’s agenda?

    Answer: Apropos , though .

    “Fryer was not alone in the APA. Because homosexuals were not allowed to practice psychiatry, Fryer and others like him had to hide their sexual preference, but they began to meet informally at APA conventions, calling themselves the Gay PA.”

    “81 Words ”
    http://en.wikipedia.org/wiki/81_Words

    Link to this
  7. 7. Ingrid Wickelgren in reply to Ingrid Wickelgren 1:23 pm 05/9/2012

    JTGILLICK: Just using a little poetic license. I certainly meant no offense!

    Link to this
  8. 8. Ingrid Wickelgren in reply to Ingrid Wickelgren 1:24 pm 05/9/2012

    peter1951: Not insulted, but those thumbnails were all put up by someone else…not sure what is wrong with it!

    Link to this
  9. 9. dawso007 11:01 pm 10/15/2012

    Fortunately there are other ways to look at things – such as the way that psychiatrists actually are trained and practice. Looking at the issue of diagnostic proliferation – it is much greater for physical illness than mental illness:

    http://real-psychiatry.blogspot.com/2012/05/why-allen-frances-has-it-wrong.html

    Link to this

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