Advancing DSM : Dilemmas in Psychiatric Diagnosis

Whatever one's attitude toward the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), it is a book that is hard to ignore. In the popular press, it is frequently described as the psychiatrists' bible, although this metaphor is probably only apt if psychiatrists are given the role of skeptical priests. They were trained with it, they have to use it in their professional work and it is occasionally helpful to refer to when talking with patients, but they often don't think it provides any deep insights into mental illness, and there are many parts of it they do not believe in at all. Clinical psychologists and social workers tend to be even less committed to it. However, it is the document that has been adopted by most bureaucratic and legislative organizations from managed care and governmental health organizations to law courts to determine when people should be entitled to treatment or their psychological state may be relevant to assessing their responsibilities for their actions. Given its importance, there should be a great deal of interest in the creation of the next edition. Two of the editors of Advancing DSM were instrumental in creating the fourth edition of DSM; Michael First was editor of the text and criteria, and Harold Alan Pincus was ViceChairperson of the DSM-IV Task Force. It is tempting to look at the table of contents for signs of alliances and new ideas that might hint at possible changes in DSM-V. For example, it is interesting that First is co-author with Jerome Wakefield of one of the chapters, since it suggests that Wakefield, who has in the last decade become widely known for his controversial "harmful dysfunction" account of the nature of mental disorder, may have influence in drawing up a definition of mental disorder for DSM-V. It is also striking that W. John Livesley contributes a chapter on personality disorders, since he is known for his critical attitude towards their current classification; the reader may speculate that the editors of DSM-V may be open to a rather radical reformulation of their classification. However, such speculation is reminiscent of Kremlinology, and assumes that the APA already has a fixed agenda and is using this book to start to hint their plans to the public. In their Introduction, the editors of Advancing DSM explain that they hope the book