Review of the DSM-V as a piece of dystopian fiction

148 点作者 carpdiem超过 11 年前

18 条评论

One of the criticisms being leveled at the DSM-V here is that "normal" is being negatively defined as the absence of disorder:> DSM-5 seems to have no definition of happiness other than the absence of suffering. The normal individual in this book is tranquilized and bovine-eyed, mutely accepting everything in a sometimes painful world without ever feeling much in the way of anything about it.Positive psychology[1] is a branch of psychology that agrees with this critique, and rather than looking at what goes wrong with people, it looks at what is right about people. There is a book "Character Strengths and Virtues"[2] that is aimed at being the positive counterpart to the DSM, providing a taxonomy of character strengths that have been identified across different times and cultures.1. <a href="http://en.wikipedia.org/wiki/Positive_psychology" rel="nofollow">http://en.wikipedia.org/wiki/Positive_psychology</a>2. <a href="http://en.wikipedia.org/wiki/Character_Strengths_and_Virtues" rel="nofollow">http://en.wikipedia.org/wiki/Character_Strengths_and_Virtues</a>

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ACow_Adonis超过 11 年前

One is reminded of other fictional works such as American Psycho, by Brett Easton Ellis. These works are valuable to read not because they are overly pleasant, but specifically because they are such transparent and horrific reflections of the inner mental state of the narrator. Such a state is then projected onto the mind of the reader so effectively that the disgust and alienation you feel while reading the book is effectively the same disgust and alienation internalised at all times by the novel's protagonist.In this the DSM-V is another brilliant piece of fictional writing. A world where everything is classified, pathologised, and detached from its context, values, society, and causes. During the entire tome, you are completely separated from any notion of wellness, love, morality, or healthy human beings, with everything classified and filed away like a work-bench with little boxes for every possible failing.It finally hits you as you feel so disgusted and alienated by the conclusion of the novel...that this is specifically because the narrator is so alienated and separated from such realities, and the novel has succeeded perfectly in its goal. To put you in such a tortured, flawed, and erroneous mindset that you now understand completely the flawed and erroneous mindset and worldview of the narrator.Kudos to the author. Another masterpiece.

andrewcooke超过 11 年前

i don't understand this. if we assume psychiatry is pretty much in its infancy, blundering around, then doesn't it make sense to give names to certain groups of symptoms? because then you can hope to identify patterns. for example: if 60% of people who do X and feel Y take drug Z then P, Q and R. isn't that how you start doing science?i used to be more sympathetic to criticisms of DSM-V, but a couple of months back i went to see a psychiatrist. who told me he didn't believe in it. fair enough. but he then diagnosed me with something and prescribed me a drug. when i asked why, he said i should trust his intuition. without DSM-V or anything similar there was no structure - nothing i could understand or question. no logic. just "intuition".maybe i am missing the point. i can see that "labels" are annoying. but surely there has to be some systematic approach to symptoms...[edit: got psychiatry and psychology swapped...]

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chaffneue超过 11 年前

This article is just purple prose nonsense that takes advantage of their audience's natural distrust of information that surrounds the human mind (see the author's reference to multiple benign conditions to discredit the work) and the author's own hang up about some sad end where "human beings are individuated, sick, and alone." From pioneers like Freud to the modern psychoanalysis spectra we have today, I see much of the body of work around human mental states being about classification/categorization, statistical aggregation, symptom/diagnosis tracking and vocabulary. The article is more or less reading a collection of codified medical anomalies and then attributing a singular, malevolent narrative tone to it instead of just reading it for what it is: a standardized professional manual with a strict written style and many collaborators. There's no narration let alone an "unreliable" narrator, there's minimal subjectivity, there are no actors, there's just some observational information presented in a standard way. While I'm aware the DSM has its critics and naff list of non-disorders, I don't believe that committing to basic research and presenting objective findings is a madness that itself belongs in the DSM. What if the goal to this manual is altruistic? What if even one patient benefits from a faster recovery from some mental malaise because of this manual? I'm inclined to say keep researching!

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fit2rule超过 11 年前

The thing about the DSM-V is that it is simultaneously a bible, a dictionary, a sales catalog, and an industrial reference manual. As a work of literature, it is the pinnacle of mans' oppression of mankind, categorized, classified. Any single manner by which one might criticize ones fellows, put them in a box, and prepare for delivery: DSM-V has it.

thucydides超过 11 年前

Great piece. Two of my favorite substantive critiques:1. "DSM-5 seems to have no definition of happiness other than the absence of suffering. The normal individual in this book is tranquilized and bovine-eyed..."The DSM does turn mental disease into an entirely negative subject: you're mentally healthy only if you lack any of the listed disorders. The name "Diagnostic and Statistical Manual" does limit the enterprise contained within, but practically speaking, the DSM is the Bible for mental health professionals. It's the document that describes a substantial portion of how to give care to the mentally sick, and no other document has the same stature.And yet their Bible contains nothing at all about mental hygiene or positive practices. Consider how odd that is, how it distorts the mental health professions. In the realm of "physical" health, medical doctors speak with unanimity on every medium imaginable about how you should exercise regularly, eat more fruits and vegetables, etc., to stave off cancer, diabetes, heart disease, and an array of other ailments. How often do you hear psychiatrists talk about the importance of working on your empathy and forgiveness skills? N.B.: doing so will make you happier.Again, cataloguing symptoms is important, but not all-important. DSM sucks all the air out of the room and leads those who study the mind to focus excessively on the neat categorization of symptoms rather than means of staving off mental illness in the first place or of developing admirable virtues like courage, self-discipline, and justice.2. "On some level we’re to imagine that the American Psychiatric Association is a body with real powers, that the Diagnostic and Statistical Manual is something that might actually be used, and that its caricature of our inner lives could have serious consequences."We know that the caricatures have serious consequences for millions of people, which ought to horrify us. I've seen the consequences of this kind of over-pathologization up close. I've had several criminal clients who've been seriously affected by faulty prison diagnoses of schizophrenia and bipolar disorder. These faulty diagnoses led to the prescription of the powerfully soporific antipsychotic Risperdal, which turned my clients into physically weak zombies, and, for that reason, into victims of sexual assault. Admittedly this is an extreme example, but it amply demonstrates the power of the DSM.

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bhaumik超过 11 年前

If anyone's curious about the changes in DSM-5 (from DSM-IV) here are the "highlights":<a href="http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm-5.pdf" rel="nofollow">http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20t...</a>Very interesting additions/clarifications.

__float超过 11 年前

If anyone wants to Google more about the book, it might help to know the actual book is the "DSM-5". They have discontinued the Roman numeral scheme in the latest edition (released this year), but some still use the old way.

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philwelch超过 11 年前

What I think a lot of people are missing is that the entire notion of mental illness is a hack. The basic definition of any mental illness requires that it interferes with ones ability to live a normal life. Resist the urge to deconstruct that for a second, I'll come back to it.Some people have problems that some type of professional help can enable them to solve. This can range from people who need medication to avoid seeing and hearing things that aren't there to people who need CBT to get out of a self-destructive rut to people who need cosmetic surgery to feel like their body fits their subjective gender. But the United States is full of systems where you need a diagnosis to do anything--bill insurance, prescribe medication, declare someone to have a disability so they can collect income without working. So DSM is a tool for psychologists and psychiatrists to put a code down on a form so the system will let them help people.This is why there's a stipulation that it's only a mental illness if it prevents you from living a normal life. Lots of people have the symptoms of mental illness, just not to such a degree that it warrants intervention. Having compulsive rituals is perfectly normal--compulsively washing your hands until they bleed is not. A good mental health professional will know the difference and only provide a diagnosis when it's necessary. But ultimately the DSM isn't a bedrock of abnormal psychology, it's just a tool psychologists use to make the system let them help people.

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chimeracoder超过 11 年前

> “caffeine intoxication disorder.”As someone who mostly appreciated the DSM-IV (though recognized its shortcomings), this is my biggest concern with the DSM-V, and why I consider it to be a step backwards in many ways.CAVEAT: My understanding of the DSM-V is based on earlier drafts/non-final editions, so some of these details may be stale, but it appears the general principles that I object to haven't changed.The DSM-IV-TR was very specific with its definitions of "substance abuse" and "substance dependence". My main complaint with the former was the way two of the criteria were poorly worded. It referred to the amount of legal trouble and/or risk that the person took to obtain the drug and could, if very broadly (mis-)interpreted, be used to identify any user of any illegal drug as suffering from "substance abuse" just by definition[0]. This is mostly a quibble about the wording of one detail, though; I think that these were good definitions overall and were more helpful than not.Criticially, the DSM-IV-TR was able to distinguish between casual users of a drug (be it caffeine, alcohol, marijuana, heroin, etc.) and those who actually suffered from "addition" (a term I put in scare quotes because it does not have a medical definition, unlike the words "abuse" and "dependence").This is a crucial distinction. If you send someone who drinks infrequently but is not an alcoholic to rehab, you are providing treatment for a disorder that they do not have. Thus, you wouldn't be surprised (or concerned) to find their behavior unchanged six months later. You would not consider it a "relapse" if they continued to drink infrequently.Unfortunately, the DSM-V turns this on its head, by allowing "fill-in-the-blank" intoxication disorders. Think of generic classes in Java - they work the same way. Given the name of any drug, you can provide the corresponding disorder - in this case, "caffeine intoxication disorder", or "marijuana abuse syndrome"[1]The problem with the new wording is that it encourages over-diagnosis of mental disorders. Instead of requiring a professional to distinguish between disorders and non-disorders (easy), it lumps all together as disorders, and requires professionals to distinguish between those which require treatment and those which don't (hard).This is not only more difficult medically, but more problematic legally. No doctor or hospital wants to accept the liability of saying that they saw a patient previously diagnosed with a disorder and then determined that they didn't need treatment. This is far worse than simply failing to diagnose a disorder.This may seem like a minor point, but it's not. We've been struggling with issues of overdiagnosis and overtreatment of non-disorders (not just drug-related) for years; in a very subtle way, the DSM-V further entrenches this problem.[0] Incidentally, DSM-V did drop the "legal trouble" criterion.[1] I forget the exact wording of the latter; this was a while ago and I believe they changed it.

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chattoraj超过 11 年前

The NIMH (National Institute of Mental Health) announced a few months ago that it would be "re-orienting its research away from DSM categories".Even the guys on the inside don't trust it.<a href="http://mindhacks.com/2013/05/03/national-institute-of-mental-health-abandoning-the-dsm/" rel="nofollow">http://mindhacks.com/2013/05/03/national-institute-of-mental...</a>

yuubi超过 11 年前

"system of repression . . . in which deviance isn’t furiously stamped out . . . but pathologized instead."For instance, <a href="https://en.wikipedia.org/wiki/Sluggishly_progressing_schizophrenia" rel="nofollow">https://en.wikipedia.org/wiki/Sluggishly_progressing_schizop...</a>

wavesounds超过 11 年前

"The word “disorder” occurs so many times that it almost detaches itself from any real signification, so that the implied existence of an ordered state against which a disorder can be measured nearly vanishes is almost forgotten. .... Here all pretensions to objectivity fall apart and the novel’s carefully warped imitation of scientific categories fades into an examination of petty viciousness."Or as Richard Feynman coined it: Cargo Cult Science <a href="http://en.wikipedia.org/wiki/Cargo_cult_science" rel="nofollow">http://en.wikipedia.org/wiki/Cargo_cult_science</a>Also lets not forget these same people claimed being homosexual was a mental disorder until 1973!

jboynyc超过 11 年前

Ian Hacking had a great review of the DSM-5 in the LRB earlier this year: <a href="http://www.lrb.co.uk/v35/n15/ian-hacking/lost-in-the-forest" rel="nofollow">http://www.lrb.co.uk/v35/n15/ian-hacking/lost-in-the-forest</a>

tokenadult超过 11 年前

I see chimeracoder has already posted a comment here. Maybe I should plunge in, after looking at the "book review" kindly posted here, to comment on psychiatric nosology (classification of disorders) in general.Basis of knowledge disclaimer: I am not a medical doctor, and I have never attended even an undergraduate-level course in psychology. On the other hand, I have been reading extensively about psychology for twenty years,[1] mostly focusing on research on human intelligence and human behavior genetics, and over the years my participation in online discussion networks gained me an invitation to participate in the "journal club" (graduate seminar course) on human behavior genetics at my alma mater. At the behavior genetics seminar, I have met several researchers who have been trying to clean up psychiatric nosology and improve the newly released edition of DSM. The researchers I know locally do NOT like the framework or approach of DSM-5. I'll try to do a layman's justice to their point of view in what I write below.We have discussed before here on HN the blog of the director of the National Institutes of Mental Health, which included a post "Transforming Diagnosis,"[2] casting considerable doubt on the diagnostic approach taken in DSM-5, which was published just before DSM-5 itself was published. Most researchers agree that to develop better understanding of troubles patients experience, and better approaches to treatment, a lot of mental disorders will have to be recategorized (including no longer being categorized as disorders) based on new criteria. That's what the progress of science will look like in this field.It's important to remember that Freudianism was still in vogue when I was young (and constituted most of the higher education in psychology that my parents received in the early 1950s) and psychology and especially psychiatry are STILL undoing some of the harm caused to those disciplines by mistaken ideas from Sigmund Freud. It's easy to tell persuasive stories about what makes people's minds work, but much harder to test those stories with evidence.Neurologists who are interested in science-based improvement of medical practice have commented[3] on DSM-5, and comments of that kind point the way forward to improvement of nosology in psychiatry in the future. Therapists may have to give up their pet "specialities" to recognize the realities of how to help patients. There will surely still have to be new diagnostic tests and new drug treatments developed. The DSM-5 didn't do as well as it ought to have to advance understanding of mental disorders. But its evident faults will prompt further research, and DSM-5 will eventually be replaced by a new edition, one I hope will be based on better science.[1] <a href="https://en.wikipedia.org/wiki/User:WeijiBaikeBianji/IntelligenceCitations" rel="nofollow">https://en.wikipedia.org/wiki/User:WeijiBaikeBianji/Intellig...</a>[2] <a href="http://www.nimh.nih.gov/about/director/2013/transforming-diagnosis.shtml" rel="nofollow">http://www.nimh.nih.gov/about/director/2013/transforming-dia...</a>[3] <a href="http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-the-heart-of-psychiatry/" rel="nofollow">http://www.sciencebasedmedicine.org/dsm-5-and-the-fight-for-...</a>

Sagat超过 11 年前

I have trouble taking psychology and psychiatry seriously. They are the softest of the sciences and mostly based on cultural norms anyway. Consider the fact that homosexuality was labelled a mental disorder in the DSM not long ago. This is evidence that they make it up as they go along.

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morgante超过 11 年前

I feel pretty stupid for taking so long to realize that this is an actual review of the DSM-5. Up until halfway through, I thought this was indeed a review of brilliantly executed satire in the form of the DSM. Though that itself could actually be a pretty interesting literary form...

DanBC超过 11 年前

> This is one of the major flaws in George Orwells’s 1984: When O’Brien laughingly expounds on his vision of “a boot stamping on a human face – forever”Sounds about right. (<a href="http://imgur.com/a/IJnR2" rel="nofollow">http://imgur.com/a/IJnR2</a>)