The Diagnostic and Statistical Manual of Mental Disorders (DSM),long the master reference work in psychiatry, is seriously flawedand needs radical change from its current "field guide" form,according to an essay by two Johns Hopkins psychiatrists publishedin the New England Journal of Medicine. "A generation ago it served useful purposes, but now it needs clearalterations," says Paul R. McHugh, M.D., a professor of psychiatryand behavioral sciences at the Johns Hopkins University School ofMedicine and co-author of the paper with Phillip R. Slavney, M.D.,a professor emeritus in the same department. "They say they can'tdo any better. We disagree and can show how." The original DSM, published in the 1950s, was intended as a publichealth service documenting the incidence and prevalence of mentalillnesses. By its third edition in 1980 (DSM-III), however, it hadevolved into a reference book prescribing how clinicians shouldidentify and classify psychiatric disorders. Today, the Johns Hopkins psychiatrists say, DSM provides checklistsof symptoms, offering few clues to the underlying causes of mentaldisease and making it difficult to direct treatment or investigatethe disorders it details. A new edition, DSM-5, is due out in 2013. The manual, put together by the American Psychiatric Association,currently identifies hundreds of conditions via lists of diagnosticcriteria and symptoms, functioning exactly as does a naturalist'sfield guide but for mental illness. It offers no way to make senseof mental disorders and no way to distinguish illnesses that appearto be similar but actually are quite different and requiredifferent treatments, the psychiatrists argue. "If you just name things and don't explain what the causes are, youdo not know how to rationally treat or study the diseases," saysMcHugh, former director of Hopkins' psychiatry department. "The DSMgives everything a name but not a nature." Before DSM-III, McHugh and Slavney say, psychiatrists typicallyused a "bottom-up" method of diagnosis, based on a detailed lifehistory, painstaking examination of mental status and corroborationfrom third parties. The new emphasis on symptoms, they say, hasunfortunately encouraged a cursory "top-down" method that relies onchecklists and ignores much of the narrative of the patients'lives. The causes of psychiatric disorders derive from four interrelatedbut separable categories: brain diseases, personality dimensions,motivated behaviors and life encounters, write McHugh and Slavney.The two physicians suggest that organizing mental illnesses basedon these four causalities would "promote fruitful thought and,consequently, progress." "Psychiatrists would start moving toward the day when they addresspsychiatric disorders in the same way that internists addressphysical disorders, explaining the clinical manifestations asproducts of nature to be comprehended not simply by their outwardshow but by the causal processes and generative mechanisms thatprovoke them," they write. "Only then will psychiatry come of ageas a medical discipline and a field guide cease to be its masterwork." Additional References Citations. I am an expert from stainlesssteelflatbars.com, while we provides the quality product, such as Stainless Steel Coils Manufacturer , China Glass Wall Fittings, Stainless Steel Round Bars,and more.
Related Articles -
Stainless Steel Coils Manufacturer, China Glass Wall Fittings,
|