Academic journal article Ethical Human Psychology and Psychiatry

The DSM-V Project: Bad Science Produces Bad Psychiatry

Academic journal article Ethical Human Psychology and Psychiatry

The DSM-V Project: Bad Science Produces Bad Psychiatry

Article excerpt

The project to develop the successor to fourth edition of the Diagnostic and Statistical Manual of Mental Disorders has been under way for 10 years, yet it is still several years from completion, and the field trials, the most difficult and expensive part, have not even started. This article explores the reasons why the project is struggling, arguing that the defects the Diagnostic and Statistical Model-V (DSM-V) Committee has found are not chance or random problems that can be overcome by more money but rather represent serious conceptual errors in the very basis of the ideas underlying the project. As a result of these errors, it is predicted that the entire notion of valid categories of mental disorder will collapse in self-contradiction. One of the most recent suggestions for a new disorder, psychotic risk syndrome (now APSS), is used to demonstrate how the principles of science cannot accommodate the unstated ideological demands driving the DSM-V project.

Keywords : DSM-5; scientific psychiatry; biological psychiatry; categorical diagnoses

Looking at the different sciences throughout history, it is probably fair to say that systems of classification have tended to generate intense feelings, and psychiatry is no exception. I have previously argued that the categorical system of diagnosis, as seen in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV ), is so seriously flawed that it cannot be improved without abandoning the basic precepts on which it is constructed (McLaren, 2007). With the projected revisions of the nosology, the psychiatric establishment has a rare opportunity to rectify its errors by enacting a number of major changes to the concept of psychiatric diagnosis.

The project to replace the DSM-IV (American Psychiatric Association [APA], 2010) has been under way for more than 10 years, involving 600 researchers as well as unknown numbers of support and other staff. It has cost tens of millions of dollars already, yet the field trials, the largest, most complex, and most expensive part, are still to come. It is undoubtedly the largest single project in the history of psychiatry, dominating the profession's thinking to an extent rarely, if ever, seen in other fields of nosology. Nonetheless, the launch date has been pushed back and back and is currently thought to be some time in 2014. Its progress has been marked by unprecedented controversy, with the chairmen of both the DSM-III and the DSM-IV Task Forces voicing stringent criticism of their successors (Frances, 2010). There is no reason to believe that the DSM-V Committee has any intention of revolutionary changes to its charge: it will be a case of evolution toward the same goal rather than revolution toward another.

In this article, I argue that this enormous project is entirely the wrong project for psychiatry at this stage of its development and that the precious resources it consumes should be directed elsewhere. Notwithstanding, even if it were the right project, it would still be wasted effort because its inherent errors mean that it is doomed to failure. DSM-V cannot achieve its basic goal of a further "seminal contribution to patient care and to the scientific study of psychiatric disorders by providing rigorous and reliable diagnostic criteria for (psychiatric) conditions" (Stein et al., 2010). Instead, it will continue the process of damaging psychiatry and reducing its importance in the world of mental health to the point where it becomes a commodity and psychiatrists themselves become irrelevant.

First, I examine some of the thinking behind the central idea in DSM-V that separate categories of mental disorder can validly and reliably be distinguished from normality and from each other. I show that this is wrong in principle, that it cannot be realized in practice, and that it puts the diagnostic cart before the causative horse. Next, using one of the new diagnostic categories, I show that it is impossible in practice. …

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