Psychiatry's Shifting Sands

March 9, 2012 | Carolyn

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The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association (APA), is the standard reference used in the diagnosis and classification of mental illness. The current version was revised in 2000, and a new edition is due in 2013.

DSM2The first edition of the DSM, published in 1952, was 130 pages long and listed just over 100 disorders. The current version describes nearly 300 disorders in 943 pages.








Every revision of the DSM is controversial, as some disorders are added and others dropped, and diagnostic criteria are changed. Criticism of the process ranges from allegations of cultural bias to suggestions that pharmaceutical companies exert a growing influence over the psychiatric profession in general and the APA in particular.

This time around, public debate is focused on a proposal to replace the three existing autism diagnoses with a single one - autism spectrum disorder. A recent New York Times article summarizes the concerns of many patients and families.

Another concern is the medicalization of human emotional experiences, such as grieving, which many people consider normal. An editorial in the February 18 issue of the prestigious medical journal The Lancet is critical of the proposal to classify grief as depression: Living with grief.

The American Psychiatric Association has created a website for the DSM-V to make the proposed revisions available for public review and comment.

Here are some books that explore the changing landscape in psychiatry:




Prescriptionsfor the mind




For a satirical look at the business of psychiatry you might like to read:                                                                                                                                                                                            Index.aspx
The Psychopath Test: a journey through the madness industry by Jon Ronson. Also available as an eBook and an audiobook.