Draft of the DSM V Just Out
Given that
a: there's a lot of interest in mental health issues around here, especially from persons with valuable lived experience, and
b: everyone loves trashing the DSM, both as a concept and in particulars,
I offer you the newly released draft copy of the DSM V. Comment is invited by the various committes, though you have to log on, so knock yourselves out! (just an expression...really)
I've barely had time to look at it myself. I note that the final publication date is May 2013, rather than sometime in 2011 as I had originally understood. I had also heard a rumor that the term schizophrenia was going the way of the dinosaur, but that is apparently incorrect, though there are some changes in the diagnostic formulations.
Look forward to getting back to this when I've had a bit of time to read it.
You know I was having a relatively good day until I clicked that link. Thanks for nothing oldgoat, damn you.
Those lists of the various "disorders" creeps me out. And it's all scientific.... until it isn't. Argh.
Sorry to ruin the editing party.
So far it's just a dream, a glint in the eyes of the Sexual and Gender Identity Disorders Work Group that is working on the revision to the DSM, the manual that mental health professionals use to diagnose and bill for their services.
What is hypersexual disorder?
Well, that's interesting, oldgoat. I shall continue to read. I skimmed the cognitive-disorder sections, also substance abuse/dependence and anxiety disorders, and I have a few general reactions, but I need to read much more carefully to grasp.
I see that they are actually replacing the term "dementia" with "major" and "minor neurocognitive disorders," and subtypes of same. I'll have to look at that and think about it a while longer. I'm not sure it matters, but it seems to me that the rationale for this is behavioural -- they're trying to emphasize diagnosis based on behaviour rather than physiological understanding of the illness and how it progresses. The virtue of doing that is that there is considerable individual variation at each stage, although the major phases through which individuals with the major subtypes progress are describable and predictable in general terms (and I found textbook descriptions of those phases helpful). I think what this tells me is either that there has been very little advance in the actual neuroscience, or that psychiatry isn't paying attention to that?
I feel kind of alienated reading the breakdowns, although the section on anxiety disorders I thought was good, substance abuse/dependence not so much, kind of mindless. It's sort of like reading Linnaeus, y'know? To me, anyway. They sound as though they're just counting things up for a while, and then refining the labels to stick on that category. It strikes me as kind of, you should excuse the expression, nutty. It's the kind of thing Swift would have written satire about.
The thing is, lay people are looking for understanding, and this kind of diagnostic guide doesn't offer them much. A wee anecdote: my guy had precisely one visit from a psychiatrist during his years of illness, right at the beginning of his time in the nursing home. Psychiatrist used most of that time talking to me, asking me questions that made me think, although never giving me time to answer. I probably said revealing things -- who knows? And then he revised a prescription that I hadn't liked to one I still didn't like. And he was gone, and two months later the nursing home doc (whom I liked and trusted very much) said maybe we should stop all medications to see whether that makes a difference, since they all have potential to cause seizures and he has seizure complication. So we did that, and ... not much happened, except I think he was better, and I sure felt better.
Is it all about the meds? Is that really all they're trying to pin down?
Yes, Skdadl, it's all about the meds. Psychiatry has become the study of psychotropics upon the human mind.
An excellent British activist, and lib-dem Sarah Brown, had something far more awesome, commonsense, and articulate than I could ever write on the subject.
Just awesome.
The trouble is that it's really not as scientific as it ought to be. Psychiatrists have noticed behaviours and/or moods that usually appear together and call that a disorder even if for the most part they don't have a clue what's really going on. There's no physical test for schizophrenia, depression, and so on. That's a problem both for finding treatments and for determining when treatments work.
The only time I ever see a full five-axis DSM diagnosis for my clients is when I ask for one because the WSIB or some insurance company or CPP Disability demands it in order to consider payment of benefits. Even workers who are hospitalized "to stabilize their meds" don't typically get rated on all DSM axes -- and it often wouldn't make much sense to do so, since you need a long view of the patient's overall condition to give a reliable opinion.
I have also noticed that the diagnosis tends to differ substantially depending who I ask, partly stemming from whether that practitioner often works on referral from that (insurance or WSIB) funder.
Only problem is that a lot of the time, they use the DSM V without using it.
-"Oh you're trans? Well we'll put you in referral to one of the two overworked septaguenarian psychologists in the province instead of giving you HRT today like any other cis woman. Why?! Well, quite simply, it's a psychological issue that gets treated by psychologists. Otherwise we wouldn't have psychologists specializing in GID, silly."
Honestly, any idiot can prescribe spironolactone and estrogen that day, and order blood work to check hormone levels and begin to put them in the normal range for the person's stated gender. It's not advanced.
When they start with labels like "Disruptive Disorder" and apply it to teenagers you know it is getting beyond silly.