Earlier this month, the American Psychiatric Association released the long awaited proposed revision of their Diagnostic and Statistical Manual of Mental Disorders (DSM-5). It is available now for public comment, with an anticipated publication date for the final version in May 2013. To call this the Bible of Mental Illness is to overestimate the significance of the Bible.
The DSM was first written to give clinicians and researchers a common vocabulary and a common understanding of the various diagnoses of mental illness. John McManamy has related this history on his blog Knowledge is Necessity. I refer you to his thorough account, found in the links at the bottom of his post. -- [Hey, John -- I recognized your image for "Few Surprises." It was one that I considered for this post!]
The way the DSM works always reminds me of a Chinese menu. For example, if you have one symptom from Column A and at least five from columns A and B, for over two weeks, you have Major Depressive Disorder. You can upgrade your core diagnosis with specials offered alongside the basic menu. These lists of symptoms provide a common vocabulary and simplify diagnosis, so that family practitioners commonly diagnose depression and prescribe antidepressants, without referral to psychiatrists. This practice provides a boon to the pharmaceutical industry, which markets heavily to family practitioners. If patients had to see a psychiatrist to get a prescription, fewer people would take antidepressants, since there is greater stigma attached to treatment by a psychiatrist, psychiatrists are in short supply in many parts of the country anyway, and health insurance plans provide inadequate coverage for psychiatric care. So family practitioners prescribing for depression sells more antidepressants. Big Pharma wants to keep the DSM simple.
Over time, even as therapists have become more eclectic in their therapies, the sequence of DSMs has more narrowly defined the illnesses which therapists treat, adding more specificity. The DSM gives a numerical identifier for each diagnosis, along with decimal points after the numbers to indicate variations and severity. Health insurance companies rely on the DSM to determine coverage. If you don't have a number, you don't get reimbursed. But they have become concerned about the multiplication of diagnoses, raising the number of claims. Health insurance companies want to limit the number of diagnoses and limit the number of people diagnosed.
The DSM was first written to give clinicians and researchers a common vocabulary and a common understanding of the various diagnoses of mental illness. John McManamy has related this history on his blog Knowledge is Necessity. I refer you to his thorough account, found in the links at the bottom of his post. -- [Hey, John -- I recognized your image for "Few Surprises." It was one that I considered for this post!]
The way the DSM works always reminds me of a Chinese menu. For example, if you have one symptom from Column A and at least five from columns A and B, for over two weeks, you have Major Depressive Disorder. You can upgrade your core diagnosis with specials offered alongside the basic menu. These lists of symptoms provide a common vocabulary and simplify diagnosis, so that family practitioners commonly diagnose depression and prescribe antidepressants, without referral to psychiatrists. This practice provides a boon to the pharmaceutical industry, which markets heavily to family practitioners. If patients had to see a psychiatrist to get a prescription, fewer people would take antidepressants, since there is greater stigma attached to treatment by a psychiatrist, psychiatrists are in short supply in many parts of the country anyway, and health insurance plans provide inadequate coverage for psychiatric care. So family practitioners prescribing for depression sells more antidepressants. Big Pharma wants to keep the DSM simple.
Over time, even as therapists have become more eclectic in their therapies, the sequence of DSMs has more narrowly defined the illnesses which therapists treat, adding more specificity. The DSM gives a numerical identifier for each diagnosis, along with decimal points after the numbers to indicate variations and severity. Health insurance companies rely on the DSM to determine coverage. If you don't have a number, you don't get reimbursed. But they have become concerned about the multiplication of diagnoses, raising the number of claims. Health insurance companies want to limit the number of diagnoses and limit the number of people diagnosed.