Is bipolar disorder overdiagnosed? Underdiagnosed? Neither? In this podcast, Dr S. Nassir Ghaemi offers his perspective on those questions.
S. Nassir Ghaemi, MD, MPH
"The main problem here is not that past DSM leaders were derelict or purely political. The problem is that they now say that they would place science below pragmatism," according to this clinician.
If science is defined as some kind of systematic study of observed experience applied to hypotheses or theories, and then confirmation or refutation of those hypotheses or theories, followed by new hypotheses or theories that are further tested and refined by new observations – if this is the core of any scientific inquiry, I think that no objective observer can attribute the history of DSM-III, IV, and 5 to anything that approximates this process.
This psychiatrist's wish is that in one more generation, our profession will learn to go beyond DSM to the truths of science.
All psychiatry, anywhere in the world, is American psychiatry. This is both good and bad.
Planck's Law of Generations: scientific change doesn't happen by changing minds, but by changing generations.
It is clear that the leadership of DSM-IV, and of DSM-III before it, views psychiatric diagnosis in the DSM system as something that should be based on “pragmatism.”
Psychiatry is a profession that deeply needs honest workers who are willing to seek a knowing ignorance, to be dissatisfied, and to refuse to conform—doing so in the interest of the truth and of the profession, seeing both as inseparable.
Although the foundational and antifoundational traditions differ in their language and claims, both call into question the legitimacy of psychiatric diagnosis and treatment.
We will have many medications in the future, he prophesied; that will not be a problem. Our challenge will be in teaching doctors how to use them, “otherwise it would be like giving a driver’s license to someone who can’t drive.”