DSM V

DSM V is the new version of the Diagnostic and Statistical Manual of Mental Disorders. There are some major changes that are very well covered in press stories (bipolar? children, Asperger’s). It’s obvious that a label such as Asperger’s can affect the expectations and actions of doctors, patients, family members and anyone else who gets involved. The new DSM gives us a chance to think about some of the following:

• What happens when a doctor applies a label to a patient. Do they get access to medication, support services, behavioural treatments? Are any of these forced on the patient?
• From the reports it seems to an open-and-shut case that some children diagnosed with bipolar disorder have been receiving heavy psychotropic drugs when they shouldn’t have been. This is a case where the changes in the DSM are clearly motivated by a desire to reduce the amount of inappropriate treatment.
• What about the people who currently identify as Asperger’s but do not necessarily fit the diagnostic criteria for the sub-class of Autism Spectrum Disorder that replaces it?  Such people might easily have Aspergian traits, but have learned, for example, to handle social interaction with a degree of smoothness and grace. Does their identity depend on fitting into a particular medical category, and if so, is that OK?
• It’s a commonplace among social scientists that labeling a person has consequences. Many mental illnesses have an associated stigma. To a degree, Asperger’s has an anti-stigma, because of the wonderful things that Aspergians have often done. So it turns out that removing the label is an act that has consequences.
• In the New York Times, Dr William Carpenter is quoted as saying ““Concerns about stigma and excessive treatment must be there. But keep in mind that these are individuals seeking help, who have distress, and the question is, What’s wrong with them?”. This is interesting, but actually the DSM is not exclusively for doctors and other health professionals, it is also a resource for people who don’t necessarily think of themselves as having anything wrong with them. I was queasy about using the term patient earlier on. This is why.

If you care to comment, take a look at DSM5.org The process looks as if it is very top down. Here’s a representative piece of verbiage.

Anyone can submit their suggestions and ideas to the members of the work groups through the DSM-5 Web site, by clicking the “Participate” button on the upper right hand side of this screen and registering. The proposed draft revisions to DSM-5 are posted on the Web site, and anyone can provide feedback to the work groups on these during periods of public comment.

Finally, members of the DSM-5 Task Force have given numerous interviews to members of the trade and consumer media to help explain the process of development to mental health professionals, consumers and family members, and members of the public, and will continue to do so through the development process.

[my emphasis]. Notwithstanding the public comment process, I don’t see a strong intent to involve. anyone who is not a psychiatric professional. I think this needs to change, or be changed.