Magazine article Clinical Psychiatry News

The Psychiatrist's Toolbox: My Hopes for the DSM-V

Magazine article Clinical Psychiatry News

The Psychiatrist's Toolbox: My Hopes for the DSM-V

Article excerpt

You will be pleased to know that no matter how long you have been neurotic, you will no longer be neurotic by 1980."

That's how I opened one of my syndicated daily radio programs one year before the DSM-III was introduced back in the late 1970s, when I was a health care broadcaster. The DSM-III was a giant departure and important step forward from the DSM-II.

As some of you might remember, the DSM-II was modeled loosely after some analytic concepts. It was not particularly descriptive. In the subsequent document, 12 neurotic disorders were eliminated, even though the word "neurosis" was important clinically in helping to describe a spectrum of anxiety in which the person in distress wanted relief. The word neurosis got replaced by a series of "disorders" where anxiety was the dominant feature.

In addition, the DSM-III made a listing of symptoms as the lynchpin of diagnosis and that approach continued to be used in the DSM-IV's various revisions, the last of which appeared in 2000.

As our colleagues work on the DSM-V, I would like to offer a few thoughts about how the manual can best serve our profession and our patients. Mainly needed are flexibility, simplicity, and humility.

Recently, I attended a continuing medical education seminar on acute and maintenance care of bipolar disorder. There were five lecturers from major medical centers across the country, all offering scientific and clinical information on this complicated disorder.

Each member of the panel approached bipolar disorder from different perspectives, offering direction to where their clinical and research studies were headed. I say "were headed" because neurobiology and neuroimaging show cerebral changes in the different aspects of bipolar disorder. However, nothing pointed to a cause.

Likewise, it seems there are a great many unanswered questions about psychiatric disorders that are dominating the current research. I am confident that sooner than later, we will know the major causes of major mental illness and will head right to treating causation.

In America today, we have about 46,000 psychiatrists and about 85,000 clinical psychologists. Add to this the larger and larger number of nonmedical therapists doing psychotherapy, including well-trained psychiatric social workers, plus thousands of other master's and non-master's level therapists. …

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