The difficulty accepting uncertainty is just as strong today as it ever has been. It leads now to excessive testing, quack treatments, and blaming the patient. We need to expand our frontiers of knowledge, but also to recognize our limitations and do the best we can within them.
We were told prior to its publication that DSM-5 would be a 'living document' subject to correction. It turns out that this correction needs to begin right now -- DSM-5 in its current form is unacceptably imprecise and cries out for an immediate and thorough re-editing.
Frankly, every new version of the manual (beginning with the first edition) has had its critics. It's always been viewed by some as "cookbook psychiatry" while others have found it immensely helpful in sorting through the myriad signs and symptoms of mental and emotional disorders.
Insel represents a crucial American school of thought -- by far the dominant one in the U.S. today -- that equates the future of mental health with the brain, pure and simple. This school of thought is fundamentally wrong, has always been wrong, will always be wrong.
DSM-5 turns the current confusion into a complete Babel. The impossibly vague and confusing DSM-5 definition of Autism Spectrum Disorder is essentially useless for clinical or research purposes and is not a trustworthy guide for determining school services.
As every other medical field has been driven by high tech and dynamic science, psychiatry has spent decades refining the art of trial and error. With more patients every year suffering from mental health disorders, it's time to take the lessons we've learned in the rest of medicine.
The point of coming out and living free and equal is to allow all to not have to create memories based on shame and fear, to allow a life and its remembrance to be based on the emotions that we all have as human beings but which are grossly distorted by the closet.
If DSM diagnosis doesn't inform treatment, what good is it? The answer is one, to facilitate the exchange of money between payers and providers, and two, to create silos for focused research. With the NIMH announcement, scratch number two.
By removing the "bereavement exclusion" from what had been considered the bible of the mental health world, the DSM's editors risk undermining bereavement as a universal, normal, if profoundly painful, experience.
May has been a dispiriting month for psychiatry and a sad and worrying time for our patients. Three of the leading mental health organizations have squabbled among themselves -- promoting silly and competing 'paradigm shifts' while ignoring the unmet needs of our patients.
We still have to rely on DSM to diagnose illness, but thanks to Dr. Insel the end of that state of affairs is a step closer. The identification and treatment of mental illness is about to leave the realm of psychiatry and enter the science of neurology.
My recommendation for clinicians is simple. Don't use DSM-5 -- there is nothing official about it, nothing especially helpful in it, and all the codes you need for reimbursement are already available for free on the Internet or in DSM-IV.