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Prescriptions for Psychiatric Trouble

February 21, 2010

Sally Satel for The Wall Street Journal:

Last week, the American Psychiatric Association unveiled the much-awaited blueprint for the next edition of its official handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, or DSM V. Outlets from the New York Times to the Hindustan Times heralded its arrival. ABC News announced, “Big changes for DSM, the psychiatrists’ bible.”

Such fanfare makes sense. The DSM is as much a cultural institution as a clinical one. As an arbiter of what is normal and what is not, the manual also plays an important role in insurance and disability determinations. In the courtroom it can bear on criminal culpability.

Scores of revisions have been proposed by nearly 200 experts under the supervision of the DSM V task force, which will release a final version of DSM V in 2013—19 years after the publication of the DSM IV. The problem is that the changes don’t really advance psychiatry. Worse, some are prescriptions for trouble. One of the most controversial is the creation of a diagnosis called “psychosis risk syndrome.” Granted, the motivation is laudable: to identify adolescents or young adults at risk for developing serious mental illnesses marked by hallucinations and delusions. What doctor wouldn’t want to intervene early to ward off an affliction like schizophrenia? But a diagnosis believed to foreshadow a full-blown psychotic illness has the potential to be highly stigmatizing. [More]

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