The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel

Since its third edition in 1980, the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association has acquired a hegemonic role in the health care professions and has had a broad impact on the lay public. The publication in May 2013 of its fifth edition, the DSM-5, marked the latest milestone in the history of the DSM and of American psychiatry. In The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel, experts in the philosophy of psychiatry propose original essays that explore the main issues related to the DSM-5, such as the still weak validity and reliability of the classification, the scientific status of its revision process, the several cultural, gender and sexist biases that are apparent in the criteria, the comorbidity issue and the categorical vs. dimensional debate.

For several decades the DSM has been nicknamed “The Psychiatric Bible.” This volume would like to suggest another biblical metaphor: the Tower of Babel. Altogether, the essays in this volume describe the DSM as an imperfect and unachievable monument – a monument that was originally built to celebrate the new unity of clinical psychiatric discourse, but that ended up creating, as a result of its hubris, ever more profound practical divisions and theoretical difficulties.

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The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel

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The DSM-5 in Perspective: Philosophical Reflections on the Psychiatric Babel

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ISBN-13:	9789401797641
Publisher:	Springer Netherlands
Publication date:	02/28/2015
Series:	History, Philosophy and Theory of the Life Sciences , #10
Edition description:	2015
Pages:	238
Product dimensions:	6.10(w) x 9.25(h) x 0.02(d)

Introduction; Steeves Demazeux and Patrick Singy.- Part I. General issues.- Chapter 1. The Ideal of Scientific Progress and the DSM; Steeves Demazeux.- Chapter 2. DSM-5 and Research Concerning Mental Illness; Jeffrey Poland.- Chapter 3. DSM-5 and Psychiatry’s Second Revolution: Descriptive vs. Theoretical Approaches to Psychiatric Classification; Jonathan Tsou.- Chapter 4. DSM-5: The Delayed Demise of Descriptive Diagnosis; Stuart A. Kirk, David Cohen, Tomi Gomory.- Chapter 5. Must Disorders Cause Harm? The Changing Stance of the DSM; Rachel Cooper.- Chapter 6.‘Deviant Deviance’: Cultural Diversity in DSM-5; Dominic Murphy.- Part II. Specific issues.- Chapter 7. Danger and Difference: The Stakes of Hebephilia; Patrick Singy.- Chapter 8. Sexual Dysfunctions and Asexuality in DSM-5; Andrew Hinderliter.- Chapter 9. The Crippling Legacy of Monomanias in DSM-5; John Z. Sadler.- Chapter 10. The Loss of Grief: Science and Pseudoscience in the Debate Over DSM-5’s Elimination of the Bereavement Exclusion; Jerome Wakefield.- Chapter 11. Against Hyponarrating Grief: Incompatible Research and Treatment Interests in the DSM-5; Şerife Tekin.- Chapter 12. RDoC: Thinking Outside the DSM Box without Falling into a Reductionist Trap; Luc Faucher and Simon Goyer.- Chapter 13. DSM-5 and the Reconceptualization of Obsessive-Compulsive Disorder: An Anthropological Perspective from the Neuroscience Laboratory; Baptiste Moutaud.

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Editorial Reviews

Reviewer: Brett C. Plyler, M.D.(Northwestern Memorial Hospital)
Description: This is a collection of essays from different authors exploring the main problems of the DSM-5. The essayists are from several different fields: philosophy, psychiatry, history, and anthropology, and their focus is not the classification system itself, but the philosophical underpinnings of the DSM in general.
Purpose: The purpose is to review and discuss the methodological and philosophical weaknesses, as well cultural bias, in the DSM-5.
Audience: The audience, according to the authors, is any of the lay public or professionals interested in a critique of the DSM-5.
Features: The book is divided into two major parts. The six chapters in the first part focus primarily on the scientific failures of the DSM in general. These vary from the misguided principles behind the DSM; how the DSM has failed to be of use in research; problems with the descriptive approach to diagnosis in mental illness; the connection between "mental disorder" and "harm;" and the difficulty of culture-bound syndromes. The seven chapters in the second part address specific issues in the DSM. The first two chapters address sexuality and hebephilia in particular (sexual preference for prepubescent children) and asexuality. The next chapter discusses the monomanias (kleptomania, pyromania, etc.) and how the diagnostic criteria for these disorders do not truly describe the level of illness patients diagnosed with these actually have. The next two explore grief, specifically the loss of the bereavement modifier, and depression, and how the DSM-5 has begun to pathologize normal emotion. The closing chapters examine the Research Domain Criteria put forth by the NIMH and how this will fit into the DSMs of the future, and the last chapter traces the subtle changes occurring in OCD and how the focus has shifted from anxiety to impulse control as the main criteria. There are numerous references at the end of each chapter as well as a concise abstract at the beginning. The introduction sets up the rest of the book well and reviews each chapter. The writing can be a bit repetitive and verbose at times, but readers are able to understand the points each author is trying to convey.
Assessment: This is a complicated topic and I found that the book evoked different responses from me depending on the chapter. The authors make some excellent points about some of the problems plaguing the DSM-5 and its previous iterations. However, some of the political rhetoric vilifying American psychiatry and decrying the wrongs it has done to the treatment of mental disorders is off-putting. The first chapter by Demazeux made me really think about how the philosophical motivation behind the DSM has changed — from one of "permanent innovation principle" (keep changing diagnostic criteria based on the most current and accurate information) to one of "prudential conservatism" (a more cautious, consensual revision process). The subsequent chapters are also very thought provoking. Discussion of the factors that impacted the creation of different diagnostic categories — insurance companies, lobbyists, etc. — and the categories we have now are artificial groupings that may not truly "fit" mental illness appropriately. Hence a reason why research does not end up supporting the validity of some of the diagnoses, even if there is good inter rater reliability. So the descriptive diagnoses allow clinicians to communicate with each other about what they have seen, but beyond that they come up short in many categories. This in turn brings up the question of how to change the DSM? Will the NIMH's Research Domain Criteria be the answer? The different authors make theoretical suggestions about how to correct these problems, but there is a lack of practical suggestions for how to move forward. The book is interesting, thought provoking, a bit verbose, at times arrogant, and highly critical of the DSM in both useful and not so useful ways, but one definitely worth checking out if you deal with the DSM at all.

Doody's Review Service

The essays in Demazeux’s and Singy’s volume are all about the DSM-5, but they also address many distinct aspects of human life, from research design to moral values, to sexuality, to grief. … the volume–and the intensity of the criticisms it contains–eloquently demonstrates the importance of the DSM to modern life. This in turn proves the importance of the collection, which contributes to our understanding of both the DSM and ourselves.” (Brent M. Kious, Metascience, Vol. 25, 2016)

“The present volume of philosophical commentary on this ambitious project offers a range of contributions to the debate about psychiatric nosology, a few of which are truly outstanding. … this volume is recommended reading for specialists and non-specialists alike interested in the problems inherent in constructing any useful taxonomy of mental conditions and particularly for insight into the science, history, and politics that have shaped the current DSM-5.” (Mark J. Sedler, Notre Dame Philosophical Reviews, ndpr.nd.edu, August, 2015)

“This is a collection of essays from different authors exploring the main problems of the DSM-5. … The purpose is to review and discuss the methodological and philosophical weaknesses, as well cultural bias, in the DSM-5. … one definitely worth checking out if you deal with the DSM at all.” (Brett C. Plyler, Doody's Book Reviews, July, 2015)

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