A psychiatrist writes a letter to the Psychiatric Times about the ongoing preparation of the latest edition of the DSM-V, the humongous – and always getting more humongous – reference book on which insurance company payment for mental illness treatment is based:
[T]here are a bunch of pre-conditions for DSM revision, which include among others, that the new version must not be a radical departure, and must be consistent and compatible with the existing DSM, thus guaranteeing continuity and preventing disruptions in the diagnosis and treatment of existing patients, assuring continuity in education and training for residents in psychiatry and existing practitioners, and in managed care and insurance coverage, and Treatment Guidelines and in psychiatric record-keeping, as well as research, unless we start labeling our diagnoses with vintage-like DSM numbers, like we label wines.
It is clear from the above pre-condition of continuity that there will be no significant departure from the established DSM path, and we can scratch the answer to our query, ie, “One psychiatrist” no matter how much he or she really wants to change the DSM [will be able to do so].
However, although they may consider introducing criteria to add dimensionality to designate severity, or the course of an illness, or degrees of impairment of symptoms, etc, for field-testing in accordance with the already existing studies on DSM defects, there will be no move in the direction of incorporating a brain-based, neurophysiologic paradigm, although there is a growing consensus which indicates that is the way to the future of psychiatric diagnosis. We are still impeded by our attachment to the scientific studies of the past. We appear to be rowing into the science of the future backwards, while anchored to the science of the past.
Background here.
October 10th, 2009 at 11:53AM
The last line is almost poetic–an allusion, perhaps to the close of The Great Gatsby?
October 10th, 2009 at 12:03PM
Funny you should say that, Dave. I thought of titling the post
And so we beat on, boats against the current…