Saturday, May 25, 2013

DSM 5, the last of its kind?

Historian Edward Shorter (author of A History of Psychiatry and many other wonderful books on the history of medicine) says there will be no Diagnostic and Statistical Manual of Mental Disorders 6, and not just because statistical and mental disorders don't belong in the title.

Professor Shorter's much more vital criticism is that DSM psychiatry's chart-toppers--major depression, bipolar disorder and schizophrenia--lack scientific backing (see his blog: This attitude carried over to the title question: the earlier version of the book had been called Diagnostic and Statistical Manual of Mental Disorders--we've always done it this way!--so we won't change it just because we dropped the statistics and mental disorders is an inappropriate designation.

There's no question psychiatrists need help sorting through the suffering patients crowding hospitals and waiting rooms. Is a flawed guidebook better than nothing?

Monday, May 6, 2013

How about "Diagnostic Manual"?

Retaining the old title: "Diagnostic and Statistical Manual of Mental Disorders" gives the impression that the editors aren't paying attention to what's actually in the book. It's being produced by the American Psychiatric Association, so the troublesome reference to "mental disorders" can depart without causing confusion. Removing "Statistical" is a brave step toward clarity since the last edition with any statistical advice was published in 1968.

Monday, May 7, 2012

What Is Mental Illness?

The Lumber Room: Mental Illness in the House of Medicine is a lively, literate examination of handbooks written to help doctors distinguish mental illness from physical illness. Evidence from the history of illness and of medicine is presented, including a glance at the evolution of the DSM, and references to epilepsy, lycanthropy, syphilis, cancer, the Capgras delusion, malaria, Alzheimer's disease, porphyria, multiple sclerosis, psychoanalysis, E.M. Forster, Samuel Johnson and Louis Pasteur. The author suggests that the editors of the next edition of the DSM, to be published in 2013, consider renaming it the American Psychiatric Association's Diagnostic Manual, since the statistical part of the book was eliminated in 1980 and the editors declared the term mental disorder unsuitable in 1994.

In the first two thirds of the essay, a critical look at these handbooks shows trends in psychiatry from the nineteenth century to today and touches on the many afflictions whose victims have been erroneously assigned to psychiatry instead of to other medical specialties. In the conclusion, the idea of a "God of the gaps" is introduced, that is, a deity whose bailiwick is everything that can't be explained by science: a poor argument for the existence of God because those gaps tend to get filled in. What these books show is a psychotherapist of the gaps, ready with psychological explanations and remedies until medicine advances and what was once, say, confusional psychosis or schizophrenia is found to be encephalitis or a brain tumor. The conclusion suggests that, with progress in medicine, difficult, unruly mental illnesses vanish and re-emerge as quantifiable, often curable physical illnesses.

If you are interested in reading more, send an email to apunctatum at with the word Lumber in the subject line or (for $0.99) download the Kindle version at or the Nook version at