Are we slaves to DSM? A South African perspective.

151 " The best protection against wild over-diagnosis is to ignore DSM-5. It is not official. It is not well done. It is not safe. Don't buy it. Don't use it. Don't teach it ". 1 These are the words of Allen Frances, Emeritus Professor of Psychiatry at Duke University, who was chairperson of the taskforce that developed DSM-IV. A scathing indictment of the diagnostic system adopted years ago by our psychiatric forbearers in South Africa (SA) – a system drilled into the minds of students and trainee mental health professionals; adhered to religiously by the pharmaceutical industry and by health management organisations for reimbursement purposes; and cited in our courts of law to support the cause of justice in our country. If Frances' advice does not concern us, then a recent statement by the director of the National Institute of Mental Health (NIMH), Thomas Insel, should cause us to stop dead in our tracks and ask 'What are we doing? Why have we been so blind? How did we go so wrong?' In a statement issued just two weeks before the official publication of DSM-5 by the American Psychiatric Association (APA) on the 18th May 2013, Insel announced " NIMH will be reorienting its research away from DSM categories. Going forward, we will be supporting research projects that look across current categories – or subdivide current categories – to begin to develop a better system ... What does this mean for patients? We are committed to new and better treatments, but we feel this will only happen by developing a more precise diagnostic system ". 2 For the director of NIMH to issue this devastating vote of no confidence on the eve of the manual's launch, suggests that something is seriously wrong. Our concern is that we mental health professionals in SA have not interrogated our loyal obedience to the DSM system and seem prepared to accept the 5th edition unquestioningly. With the new manual available on the shelves later this month at a staggering R2500, we seem prepared to prescribe it to our students as a core text, train and examine our registrars entirely in terms of its diagnostic categories and criteria, continue to base our evaluation and management of patients on its checklists, and hold it up as the gold standard diagnostic system for psychiatric research. Why are we not questioning and reviewing our reliance upon, and …