The Debate on DSM-V With Scientific American Continues

As part of a series on DSM-V at Scientific American blogs, editor Ingrid Wickelgren hosts an article by Ferris Jabr on her blog. The central premise of the article is that for DSM-V ‘science remains a stranger’. The interested reader can look at the post in more detail through the link above but for the sake of convenience I will list the main points in the article as I see them and address them point by point.

#1 DSM-V is ‘routinely lambasted as fiction borne out of convenience rather than a solid clinical text grounded in research’.

There are several responses to this

a. Firstly I would argue that this is simply rhetoric. The author neither specifies what types of criticism are being referred to nor cites evidence for this. It could just as well be said ‘routinely used as a solid clinical text grounded in research rather than routinely lambasted as fiction borne out of convenience’.

b. Even if the DSM-V is criticised, this may say more about its success than about any validity of the criticisms.

c. Furthermore relevant criticisms are a necessary part of normal science. They constitute the way that a science develops. For any scientific journal it is essential to communicate to the general public the importance of criticism in the development of a scientific discipline. Thus the point needs to be made that scientific criticisms are absolutely essential.

#2 ‘Indeed many of these changes could have been made years ago’.

The author argues that some changes were long overdue. However no specific changes are mentioned which prevents us from understanding what the author is referring to. Although the author refers to a previous feature article this contains so many changes that it is difficult to see which is relevant to his statement e.g Does he mean that changes to psychosis were long overdue or that the severity of symptoms will be graded?  We can also argue that changes have been delayed until field trials have been completed. In other words until the scientific evidence was available.

#3 Six Schizophrenia categories are being removed and the author argues that they were not based on empirical data.

The author needs to understand Psychiatry from a historical perspective and I would highly recommend Thomas Kuhn’s ‘The Structure of Scientific Revolutions’ which illustrates how essential this approach is to commenting on science and how the language relates to that community. Schizophrenia was originally derived from the concept of Dementia Praecox which in turn was based on the lifetime observations of Emile Kraeplin, a giant in the field of Psychiatry. He published his work on Dementia Praecox in the fourth edition of Lehrbuch der Psychiatrie in 1893.

These observations were empirical observations in the truest sense and lay the foundations for our understanding of Schizophrenia. These foundations gave rise to the subsequent work in refining the construct of Schizophrenia which rather than being plucked out of the air arise from an empirical tradition spanning two centuries. Also one of the subtypes – Catatonic – is such a common feature that is becoming a mandatory descriptive term for all cases of Schizophrenia and so the remark that it is being removed is inaccurate.

#4 ‘The APA is nixing three of the 10 current personality disorders, essentially acknowledging that these were never legitimate illnesses in the first place’.

The author references the APA statement on personality disorders and it is difficult to know if he has read it, as it clearly says that the six personality disorders can be generated from the new criteria which also allow for a description of healthy personality types. So the author is wrong again.

#5 ‘The DSM-5 collapses four of the five current pervasive developmental disorders – including autistic disorder and Asperger’s into a single category….because there is so much overlap in their respective criteria’.

The author’s point is unclear. Diagnostic categories are being collapsed into a single category.

#6 ‘Study after study has failed to discover a set of genes of unusual brain structures that reliably identifies major mental disorders’.

This statement suggests that the author is completely unaware of a number of important gene relationships which have even been published in Scientific American (e.g Alzheimer’s Disease genes in Scientific American, Autism genes in Scientific American, Bipolar and Schizophrenia genes in Scientific American – very good science journalism in evidence in these reports)

#7 ‘In the past, many psychiatrists have criticised the APA for not creating an independent review committee to examine this literature – a group of scientists who are not obligated to appease the APA’.

The authors is suggesting that those contributing to the DSM-V are not independent and that they will ‘appease’ the APA. The author thus makes assumptions about how the scientists will behave but absolutely critical here is for the author to provide the evidence as it could be argued that he is questioning the professionalism of the scientists. Even though there is a quote from Allen Frances it in no way negates the need to qualify the assertion about the DSM-V taskforce which consists of people who will have dedicated their lives to diagnosing and treating mental illnesses.

#8 ‘Since 2010 the APA has been diagnosing field trials for the proposed DSM-5 diagnostic criteria’

Actually the dialogue for DSM-V in the scientific literature dates back as far as 1997 and field trials lasting over 6 years have been used in the revision of the diagnostic criteria.

In conclusion, I am not convinced by the author’s arguments. Many of the criticisms are vague and need to be better clarified. Some of the links contain information which seem to contradict the author’s assertions. The author criticises the empirical basis for diagnoses whilst overlooking the works of Emile Kraeplin. The author also overlooks some examples of excellent scientific journalism in Scientific American which illustrate the relationship between genes and mental illnesses. Finally the author also overlooks an abundance of research literature which shows just how much work has gone into DSM-V and over a considerable period of time.

I may be wrong on some of these points and look forward to being corrected if so.

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