The DSM must tread carefully...

This is a momentous year. Aside from the Olympics coming to London, and the Queen's Jubilee, this is a big year for science, psychology and human kind. This year is the year that the DSM-5 comes into its final stages of drafting, writing, peer-review and then final publishing due in 2013. The DSM is the Diagnostic and Statistical Manual of Mental Disorders, and this will be the fifth edition. It's a big deal, because our understanding of mental disorders has increased dramatically since the DSM-IV was published in 1994. For example, previously separate disorders autistic disorder, Asperger's disorder, childhood disintegrative disorder and PDD-NOS will now all be under the diagnosis of 'autistic spectrum disorder'. While some worry this will 'leave people out' and lose the diagnosis parents sometimes have to battle for, it is a development very much in line with psychology and psychiatry and our understanding of autism as a whole.
The DSM-5 has already attracted large amounts of controversy, before it is even published. The problem lies, as it so often does in the fields of psychology and psychiatry, in where the line between science and statistics, humanity and understanding is drawn. Psychology is largely not a study of particles, chemicals, empirical knowledge and tick-box answers (though all these things come in, as it is a scientific discipline) but instead a study of people. People are anomalous, individual and strange. Sure, symptoms can be measured and observed, categorised and defined - but the same feeling can make one man cry and another barely flinch, the same event can make one run to friends and another retreat to isolation, and, importantly, we all use language differently. Could one man's 'depression' be another's 'bad day, bad week, bad year'? Similarly, should we be diagnosing as mental illnesses such things that many people count as everyday life - is shyness an illness? What is an illness? These are philosophical issues, but ones important to such a fundamentally human science. The DSM has a job to do (Vaughan Bell's discussion of this was the inspiration for this entry) - it needs to make diagnosis distinct and clear, widely applicable and widely observable. It needs to be enabling rather than disabling, giving patients access to treatment, and crucially solutions. But the DSM also needs to stay faithful to the fact that psychiatry is a human science, and while certain illnesses demand certain drugs, treatments or allowances, there is no 'tick-box' for emotion, sensation, description and subjectivity.
I will forever stand by the scientific nature of psychology - though it is often looked down on, both by those in the more 'scientific' field of psychiatry and Joe Bloggs on the Street. I believe that Psychology is the most important science, because it is the science of us. Philosophy, drug development, chemistry, medicine and 'hard sciences' are all valid, necessary and true in many respects, but psychology does not deserve to be shelved next to homoeopathy or astrology. It's science; it's diagnostics, and most importantly, it's solutions. However, if psychology is bullied too far down the labelling road, and diagnostics forced to lie only in the observable and categorical - then this science will surely lose its relevance, importance and unique nature.
We must all be on our guard to defend our favourite science. We must all remember and appreciate the reality of mental illnesses - even those we cannot see. And just like the press, the researchers and Joe Bloggs on the street,  the DSM must tread carefully.


Interested? Read Vaughan Bell's Article on the DSM-5: http://blogs.discovermagazine.com/crux/2012/05/22/what-is-the-bible-of-psychiatry-supposed-to-do-the-peculiar-challenges-of-an-uncertain-science/
Check out the DSM-5's very own website: http://www.dsm5.org/Pages/Default.aspx
And keep your eyes and ears peeled over the coming months!