(Please see Counterpoint article by Michael First, MD, and Robert L. Spitzer, MD)
The American Psychiatric Association's DSM diagnostic system has outlived its usefulness by about two decades. It should be abandoned, not revised. Its primary achievement was to force American psychiatrists to recognize that not all patients presenting with florid psychoses had schizophrenia. More generally, it aimed to force the idea of operationally defined syndromes down the throat of a profession that was still, in the 1970s, dominated by the vague and archaic concepts of psychoanalysis at its American 1950s worst.
These goals have long since been accomplished, and, like the preceding analytic vagueness, it is time for the arbitrary, legalistic symptom checklists of the DSM to go. (The lag time would be about the same, 20 years or so.) Let me say at the outset that I do not wish to disparage all the hard and well-intentioned labors of the various work groups that developed the different sections of these books in their several editions or to deny the enormous amount of information summarized therein. But again, the aggregate is an awkward, ponderous, off-putting beast that discredits and diminishes psychiatry and the insight of those who practice it.
Consider the fact that your clinical practice is governed by a diagnostic system that:
- is a laughingstock for the other medical specialties;
- requires continual apologies to primary care doctors, medical students, residents, and the occasional lawyer or judge;
- most of our thoughtful colleagues privately rail against;;
- insists upon rigid categories that often serve only to confuse and misinform patients and their clinical workers (sometimes abetted by televised drug advertising);
- is so intellectually incoherent as to raise eyebrows among the well-educated, critical thinkers in our own psychotherapy clientele;
- persuades the world at large that psychiatry no longer has anything of interest to say about the human condition.
If it were within your power to do so, wouldn't you get rid of this system?