DSM-5: A Manual Run Amok

5/18/13. Paul McHugh, MD:

"It's time for psychiatry to drop its field guide and try to learn about mental ills."

http://online.wsj.com/article/SB10001424127887324216004578483391664789414.html?KEYWORDS=a+manual+run+amok

My response:

Dr. Paul McHugh (“A Manual Run Amok”, 5/18-19/2013), reminds us that psychiatrists, psychologists, and other mental health clinicians have not penetrated the secrets of human nature. The DSM-V “field guide” to psychiatric disorders, he implies, consists of a list of ingredients for many psychological disorders with no recipes for the causes or etiology of any of the increasing number of mental maladies. To ask what mental illness is --- is to get answers that often sound muddle-headed or simple-minded.

In their pioneering text, “The Perspectives of Psychiatry,” Drs. McHugh and Phillip Slavney promote  conceptual clarity when diagnosing and treating mental distress. Because we have no clue how the brain creates consciousness, psychiatric disorders, they say, must be viewed, for now, as unique combinations of diseases (e.g. schizophrenia), dimensions (e.g. personality traits, temperaments), behaviors (e.g. addictions), and life stories (e.g. traumas). No one method or approach captures the complexity of an individual’s mental life. There are no substitutes for getting to know much more than the patient’s presenting symptoms.

Over the last 100 years, mental health clinicians have learned much to help alleviate mental anguish. We know that most people who get psychological therapy feel demoralized and these people often benefit from psychological therapy. Many benefit from life-saving psychiatric medications. Even more benefit from a combination of medication and psychological therapy. Some patients get medicines they don’t need. Many more patients never get the medicines they require. It is difficult to get adults to take eight days of antibiotics to treat an infection. It is much harder to get patients to regularly take medicines for their mind if they don’t help.  

Given the million-billion or so connections between the neurons in our brains, there are ample reasons for our lags in explaining the causes of problems in our minds’ “hard-ware” and  “soft-ware.” We understand much more than we can explain.

In these days where clinicians are burdened by checklist short-cuts, insurance mandated restricted number of therapy sessions,  required quick fixes of medication without knowing the patient, to name a few, there is often a rush to a non-judgment where a diagnostic manual can run amok.

S. Ceresnie, Ph.D.