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Streams of Consciousness

Streams of Consciousness

The scoop on how we think, feel and act

Psychiatrists Are About to Shift the Boundaries between Sane and Insane

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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.

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

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