Alchemical Thoughts

Trying to figure out the DSM IV

Posted on: August 23, 2010

My two readers might know that I write a semi-regular feature for our library blog entitled "Reference Book of the Week." What I usually do is look over a specific reference book, see what makes it useful, and highlight why someone would want to use it. Here is a sample post, the one I wrote for the Digest of Education Statistics. I was going to write a post for the DSM IV, but I came across a few issues. Anyhow, while I chose not to publish the post in the library blog, I still wanted to make a note of my observations about the book and share them. Do note that while I link to the Wikipedia article on the DSM IV for convenience here, it is something I would not do on the library's blog (even though I think that at times Wikipedia can have its uses for quick ready reference).

One of the prominent issues with the book is that it is not terribly intuitive. It is meant to be used by trained practitioners. This probably explains why I get the occasional student complain about how difficult it is to use. It takes some time to go through it and learn how to find what you need.

What follows is the draft I started for the library's blog:

* * * *

The DSM IV, currently in its fourth edition, is the classification manual for mental disorders. It is used by clinicians and researchers in various fields such as biology, social work, psychology and psychiatry, counseling, etc. This manual is the result of a long journey to classify and define mental disorders and illnesses that started with a desire to gather mental health statistics. When did the effort start? According to the manual's introduction, "what might be considered the first official attempt to gather information about mental illness in the United States was the recording of the frequency of one category– 'idiocy/insanity' in the 1840 census" (xxv). Over time, the American Psychiatric Association, in collaboration with other groups, developed the vocabulary and definitions that eventually became the DSM. The DSM basically provides criteria to diagnose a mental disorder, and the clinician doing the diagnosis would follow that criteria using a specified assessment system (the multiaxial system) to reach a diagnosis.

* * * *

Next are other things I wanted to write about or include in the draft:

  • The manual has become a medical billing tool. Government and many insurance companies often require a specific diagnosis to approve payment for treatment. This issue does raise some questions about the use of the manual for things other than its stated purpose, and I think it is something that students should recognize. I think it may also make for a good information literacy lesson in terms of questioning a source.
  • The compilers of the manual have been very inflexible in terms of making changes. In addition, there have been and continue to be controversies over the DSM. For instance, the notable inclusion of homosexuality as a disease; homosexuality was not removed until 1974, and to this day a lot of religious and political interests, which have nothing to do with science, continue to grouse over the 1974 removal of homosexuality from the DSM. In addition, the most current edition, the DSM IV TR (text revision) still includes sex-related diagnoses on the basis of sexual paraphilias (fetishes) for instance. I am sure any consenting adult who enjoys a little fetish play has a thing or two to say about that. Overall what this illustrates is that there are political and religious interests trying to bring influence to the scientific endeavor, plus keep in mind that those compiling the book have had their own interests as well. This is definitely the kind of thing that I think should be discussed with students, but I could not bring myself to write about it in the library blog, which is considered an official forum, and given certain community sensibilities, bringing up something like sexual paraphilias, even to make a point, could get me in hot water. I have to choose my battles.
  • In the end, what I would want students to take away from this is that the DSM IV is a very specific reference book, to be used mostly by trained professionals, but that it is not without controversy. The book is not infallible. In fact, it has been edited and changed over time as we gain new knowledge or realize that something should not have been labeled a mental disease in the first place.

And there are my thoughts as I learned a bit about this manual.

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