The New DSM V - Helping Patients or Hurting Them?

By: Richard Failla, Chief Executive Officer

It is interesting to follow all the articles about the new Diagnostic and Statistical Manual V (DSM V). We are seeing more criticism about DSM V then we have about any other previous manual revision. Actually, the criticism is not new. Almost every edition has had its critics going back to the early 1990’s when 'The Selling of the DSM', a book by Stuart Kirk, and 'Making us Crazy', a book by Herb Kutchins, appeared on the scene. What makes the current criticism of note is that the attacks are coming from within the Profession of Psychiatry. One of the leading psychiatric researchers who was in charge of developing the DSM IV, Allen Frances, says that the authors for the DSM V have failed to ask the most important question: Will the new diagnosis help patients or harm them?

The National Institute of Mental Health (NIMH) has come out strongly against the DSM V to the point of saying “Mental Disorders are biological disorders involving brain circuits that implicate specific domains of cognition, emotion, or behavior.” NIMH plans to produce precision medicine that would treat disorders. Unfortunately, no lab tests exist for depression, schizophrenia, or bipolar disorder.

Dr. Frances has written a new book called 'Saving Normal'. In this book he talks about the fact that “all of our diagnosis are now based on subjective judgments that are inherently fallible and prey to capricious change”. Dr. Frances goes to say that it's impossible to define normal let alone “Mental Disorder”. But that doesn’t mean we can’t talk about the problems that cause human suffering. 

In the hospital setting we mainly see patients who suffer from severe and persistent mental disorders. Primarily, Major Depression, Bipolar, Schizophrenia. The reason for this is the interruption of a person’s life because of these disorders, and a threat to self or others. Treatment requires a complex array of medication, social support, therapy, attention to the living situation upon discharge, as well as employment.

I have seen many changes in diagnosis since the DSM II. At the end of the day I am not sure that having subjective diagnostic criteria is the most important thing to be concerned about when treating mental disorders. In my opinion, it is far more important to have the ability to listen to what the patient is telling you about an out of control life and to be therapeutically present and focused on the patient's need for compassion and understanding. I do believe that eventually we will find a cure for the brain disorders that make life unlivable for so many people.