III. DSM-V AND SCIENTIFIC VALIDITY ISSUES
The DSM-V is now being introduced to the psychiatric community, to mixed reviews. There are controversies that involve several aspects of the changes involved to this “bible” of mental illness.
Dr. Joel Paris, MD summarizes some of the controversial points:
Is the DSM-V system an improvement? One would like to believe so, and there are a number of places where it is. But there are four problems. Some derived from the concept that psychopathology lies on a continuum with normality. This makes it difficult to separate mental disorders from normal variations, and therefore runs the danger of overdiagnosis other problems derived from the principle that mental disorders are brain disorders. Although great progress has been made over the last few decades, and although neuroscience has explained much about the brain, the origins of mental illness remain a mystery. No brain scan can explain why people develop schizophrenia, mania, or depression.[29]
He notes that the multi-axial system is gone, and that criteria have been expanded, likely leading to more frequent diagnoses.[30]
It is lamented that there is such little progress toward the scientific validity that is the hallmark of medical science otherwise:
Almost all DSM diagnoses are based entirely on signs and symptoms. Some disorders have attracted more research, providing at least some support for validity, and although observation can be made more precise through statistical evaluation and expert consensus, other areas of medicine use blood tests, imaging, or genetic markers to confirm impressions drawn from signs and symptoms. Psychiatry is no where near that level of knowledge. No biological markers or tests exist for any diagnosis and psychiatry. For this reason, any claim that DSM-V is more scientific than its predecessors is little but hype.[31]
Given the Texas Supreme Court's laser-like focus on clearing any pseudo-science, subjectivity, or otherwise unreliable expert evidence out of civil litigation, this should give advocates great pause:
Because we have to live with a diagnostic system that is provisional – and that will almost certainly prove invalid in the long run – much of the research on mental disorders has to be taken with a grain of salt.[32]
It gets worse:
The legal system: lawyers and judges will also be interested in DSM-V. Psychiatric diagnoses have found their way into the court system affecting everything from criminal responsibility to custody rights and insurance payments. Although the science behind diagnosis does not justify any of these practices, they are widespread.[33]
Ultimately, these criticisms (which are not isolated), seem to betray a scientism[34]that expects of the study of mental illness what it, by its nature, cannot deliver. That if it is not chemically/biologically measurable, it is not real:
But observation needs to be augmented by biological markers, as has been done and other medical specialties. In the absence of such markers, we cannot be sure that any category in the manual is valid. We should therefore not think of current psychiatric diagnoses as "real" in the same way as medical diseases and listing them in DSM-V does not make them real. For example, broad categories such as "major depression" in no way resemble diseases.[35]
It is worth noting here that the Texas Supreme Court, as far as it has gone, has not adopted such a physically reductionistic account of mental illness so as to not only elevate the burden of proof, but wholly transfer it to another discipline, with its rules and methods, altogether.[36]
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