Tuesday, May 7, 2013
Tensions rising around the release of DSM-5
In a much discussed blog posting, Dr. Thomas Insel, the Director of the US NIMH has publicly critcized the upcoming (in about a week) release of DSM-5. The updated manual will be released at the American Psychiatric Association's Annual Meeting in San Francisco. This kind of public correspondence tends to attract attention, probably because it seems like a public fight. However, the discussion, e.g. see this article, really seems to reflect a longstanding dissatisfaction with the performace of DSM-IV and perhaps annoyance that DSM-5 will not bring psychiatry "into alignment" with the rest of medicine by adopting more "biological" disease definitions. For me, it is hard to identify very much that is new in this debate. The revolution in social and cognitive neuroscience would, on the one hand, seem to be softening the distinctions between biological, psychological and social perspectives while on the other hand proponents for the primacy of one of these perspectives continue to fight the old battles on the sidelines. DSM seems to be a kind of lightning rod for this - viewed either as a psychosocially oriented "fluffy" system, sadly divorced from the kind of biological reality that would allow psychiatry be taken more seriously (like cancer!), or alternatively as a kind of powerful tool of the "biomedical" way of thinking. I tend to view it as a simplistic, but (somewhat) useful, approach to rough categorization and communication. Not to be taken too seriously and certainly not to be taken as a recipe for making clinical decisions, but also our most solid link to our empirical evidence-base and therefore not to be dismissed for reasons of dogma or philosophy.