The Battle Over DSM-5—2011
As the Networker moves into the next stage of covering the important developments within our profession, one thing seems sure: no story will have more far-reaching implications for the future of the mental health field at every level than the already tumultuous struggle brewing over the next edition of the Diagnostic and Statistical Manual, the “bible” of therapeutic practice.
Despite delays, the American Psychiatric Association (APA) is now firmly committed to bringing out psychology’s revised bible, DSM–5 by 2013. Nonetheless, an unprecedented outcry from past DSM lead editors and members of DSM–5 work groups has been highly critical of the compilation process, of several proposed new diagnoses, and of a major new diagnostic procedure. They say that the work groups are too quickly making decisions that aren’t supported by the research. Not mincing words, Allen Frances, lead editor of DSM–IV, fears the 2013 deadline is becoming “a rush to produce an inferior product.”
The increasing impact of the DSM can’t be underestimated. Originally intended primarily to create a more coherent taxonomy of mental disorders, it now helps shape insurance coverage, lawsuits, criminal prosecutions, and even how we think of ourselves and others. When homosexuality moved from a disorder to a normal expression of sexuality, for example, the attitudes of many gay and straight people shifted, which then influenced social legislation and cultural norms. Its inclusion of PTSD led to a wide range of groundbreaking research and opened the door to millions of dollars in lawsuits and disability payments. From an economic standpoint, its diagnostic categories have led to the increasing use of psychotropic medications, making it a treasure trove for the pharmaceutical industry.
Like earlier editions, DSM–5 will be a blend of hard science, political compromises, educated guesses, and research biases. Frances knows firsthand what this combination can create. . . . [Those concerned about the production process warn] of the unintended consequences of rushed deadlines that force decision-making ahead of good science and, however well-intentioned, subvert the fundamental medical principle of doing no harm. “We used to say proudly that DSM was never on the leading edge, but always on the following edge,” says [Columbia University psychiatrist Michael] First. As DSM–5 rushes toward its 2013 deadline, critics are trying to ensure that, if they can’t slow it down, they can at least help make the final decision-making more conservative.