The long-awaited update to the clinician’s guidebook DSM-V was released on May 18th, affecting mental healthcare for billions worldwide. How well is it keeping up with the latest developments in science, technology and ideas?
How will diagnosis and treatment change in a world where rapid progress in neuroscience, genetics and social concerns about ‘labeling mental conditions’ (to name but three of many innovation issues in this field) increasingly challenge the ‘behavioural’ and ‘symptomatic’ approach that forms the basis of the ‘categorisation’ upon which the DSM is founded?
An enormous amount of innovation has happened since the last major revision of this work (DSM-IV TR which was released over 12 years ago in 2000).
Neuroscientific investigative tools are revealing a seemingly endless variety of essential things about the condition of a person’s brain (including many hitherto undiscovered features of DSM-categorised ‘mental dysfunction’) that neither physical behaviour nor symptoms can fully account for, unless you completely redefine both of those terms in ways which may well be at odds with traditional and current ideas about ‘clinical diagnosis’.
Similarly, genetics can tell us things about brain related issues which, although they may ultimately have a direct bearing upon behaviour and symptoms, they do not necessarily ever manifest themselves as either behaviour or symptoms in a particular patient, often because they constitute nothing more than something ‘unexpressed’ such as ‘susceptibility’ or even the propensity to confer such things as susceptibility upon future generations.
This is further complicated by ‘epigenetic interactions’ between genetic and non-genetic physiology where they have an impact upon mental conditions: DSM can only deal with ‘expressed’ conditions.
Finally, discussions about ‘labelling’ (which is what DSM is aimed at facilitating through its system of categorising conditions) are beginning to put just about every aspect of the categorisation issue under the spotlight.
This upsurge of attention is bringing heated arguments on both sides of a long-standing disagreement (about the nature and benefits of the current diagnostic approach) to a much wider audience.
This is not to say that DSM itself has not introduced its own innovations (even if you ignore, which you probably can’t, all the numerous changes to both the book’s categorisations and its categorisation systems since the last edition, DSM-4) of which technology and communications are only two of many.
I felt it was time to go and seek out a couple of videos covering quite different perspectives on these issues in some depth.
If proof were needed that innovations in psychology which (can at least be claimed to) come from ‘outside of exclusively pathology-based psychological characterisation’ can have an impact on diagnostic issues, Elaine Aron‘s highly regarded work on ‘sensitive personalities’ is as good an example as any.
It has its roots in neuroscience and genetics and opens up new ‘labelling’ issues, but does not seem to be unavoidably committed to ‘pathology’, even though it ‘raises support issues’ which have direct relevance to mental healthcare.
The entire field of psychometrics (which her work bears upon) is another excellent example of a world of research and practice which inevitably straddles the boundary between ‘classifying abnormality’ and ‘measuring without necessarily making or impacting clinical healthcare assessments’.