Butting Heads [DSM update]

TheGlobeandMail.com – news/commentary/letterstotheeditor – What Readers Think
Published Sunday, Jul. 10, 2011.    Stephen Wiseman, Sid Frankel, & Anton Miller

It was not psychiatrists, the Diagnostic and Statistical Manual diagnostic system or the pharmaceutical companies that steered American psychiatry toward its prescribing habits and 10-minute “med-checks,” but the quest for profit over quality through managed care, intersecting with society’s age-old stigma against mental illness (Ian Brown Makes A Diagnosis – Focus, July 9.)

Without quickly offering a diagnostic label and a prescription, there are very few ways to make a living as a psychiatrist in the U.S. today. We do not face these issues in the same way in Canada.

Inherent in the DSM system is the necessity that the condition leads to clinically significant distress or clear and measured impairment in social and occupational functioning.

There are many challenges faced by psychiatry, which is as imperfect an endeavour as any other. More attention and less hysteria in delineating them would have improved Mr. Brown’s diagnosis.

Stephen Wiseman, Vancouver

Ian Brown’s sound diagnosis of psychiatry and its diagnostic system logically leads to the conclusion that establishing the diagnostic system should be a public policy matter, not left exclusively to psychiatry.

Sid Frankel, Winnipeg

Disagreement exists within the medical and psychiatric communities about the actual nature of the mental disorders listed in DSM. “Nominalists” regard these as names created to describe collections of symptoms, whereas “essentialists” believe these disorders are akin to diseases that actually exist.

The underlying meaning and validity of diagnosis in mental health therefore remains contentious, but more and more pressures and incentives exist to diagnose these conditions as if they were medical diseases.

For example, certain diagnoses (such as autism spectrum disorders) selectively unlock access to community-based interventions and supports, thereby creating strong incentives for the pursuit and making of the diagnosis.

Anton Miller, Vancouver

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