THE RISE AND FALL OF THE DIAGNOSTIC AND STATISTICAL MANUALS
(“Psychiatry” is a specialty of medicine dealing with the “study, diagnosis, treatment, and prevention of
mental disorders.” A psychiatrist is a physician who specializes in psychiatry. And, as a physician, he or
she swears and/or adheres to a “Hippocratic Oath” which is attributed to the great Hippocrates of Cos [c.
460 B.C.-c. 370 B.C.]. This founder of the “Hippocratic School of Medicine” is considered by some to be
the “father of western medicine.” That is, he established “medicine” as a separate discipline from the
disciplines of philosophy and theurgy [i.e. the “practice of rituals”].
In its original form, the “Hippocratic Oath” required a “new” physician to swear to the Greek “healing
gods” that he or she would uphold “a number of professional, ethical standards.”
And, the essential theme of the oath, then and now, is “to do no harm”…. to the patient.)
Typically, epluribusunumxiii.net would avoid discussing such a technical subject as the “Diagnostic and
Statistical Manuals of Mental Disorders (DSMs) of the American Psychiatric Association (APA).” But, the
current edition of the DSM (i.e. DSM-V: May 16, 2013) is such an extreme example of the manner in
which corporate influences (i.e. “Big” pharmacology and “Big” finance) can convert a professional work
into a project of such “self-serving nonsense and distortion” that this rule will not be followed.
And, the extreme danger of DSM-5 to the American many (e.g. by encouraging the overuse of
“medications” for children and adults where behavioral treatment strategies would be more suitable
and less invasive) cannot be overstated.
Please see some other examples of criticism which are listed below.
The DSM is the registered trademark which is owned by APA: and, its series of manuals are utilized to
diagnose, define, evaluate, treat, and communicate a listing and description of “mental disorders.”
APA’s series of manuals have included DSM-I (1952); DSM-II (1968); DSM-III (1980); DSM-IV (1994);
DSM-IV-TR (2000); and DSM-V (2013). And, for the purposes of this work, DSM-III (and later revisions)
will receive the principal focus although all of APA’s published manuals share similar “strengths and
weakens.”
In general, the APA and the “American Psychological Association” (also, acronymically, the APA) are at
odds concerning the scientific bases of “mental disorders” especially since the publication of DSM IV (in
which the medical view of the “American Psychiatric Association” [i.e. “The vast majority of ‘mental
disorders’ are diseases.”] was beginning to be over-emphasized to the point of de-emphasizing the
behavioral view of the “American Psychological Association” [i.e. “The vast majority of mental disorders
are environmentally learned.”]. That is, “mental disorders” are disease entities v. “mental disorders”
are learned entities.
It should be noted that “Psychodiagnosis” or “Psychodiagnostics” is a part of clinical psychology (i.e. a
specialty within “Psychology” which concerns itself with diagnosing, evaluating, and treating “mental
disorders”) that emphasizes the assessment of “mental disorders” by the use of a variety of measuring
techniques, especially standardized, psychological instruments or “tests.” And, DSM-V is, unfortunately,
the diagnostic language of clinical psychology as well as the diagnostic language of a number of other
mental health disciplines.
(The “International Statistical Classification of Diseases and Related Health Problems” [ICD] is published
by the “World Health Organization” [WHO] of the “United Nations” [UN]. This publication includes
criteria for “mental disorders.” The coding system utilized in the DSM is constructed to be isomorphic
with the mental health codes of the ICD. The current edition of the ICD is ICD-10 [1994]. And, a new
edition of ICD [ICD-11] is projected to be published in 2015 [with a revised section on “mental
disorders”]. The ICD-11-CM of the ICD-11 has been corrupted by the same corporate, political forces
which have reduced DSM-V to a simple tool for generating more “blood profits” for “Big” pharmacology,
“Big” finance, and “Big” healthcare.)
The clinical structuring of the DSMs, the “Multiaxial Classification System” [MCS], which was created
with the publication of DSM-III (1980), was inventive as well as clarifying, at least initially.
Under the MCS, a complete diagnosis consisted of five “Axes” which are presented with the applicable
diagnostic coding and with the name of the “mental disorder” that it represents.
Please note the following outline for a complete, clinical diagnosis in terms of DSM-III and its later
revisions:
Axis I: “Clinical Syndromes”
“Conditions Not Attributable to a Mental Disorder That Are a Focus of Attention or Treatment”
“Additional Codes”
Axis II: “Personality Disorders”
“Specific Developmental Disorders”
Axis III: “Physical Disorders and Conditions”
Axis IV: “Severity of Psychosocial Stressors”
Axis V: “Highest Level of Adaptive Functioning Past Year”
The DSM defines a “mental disorder” as “a clinically significant behavioral or psychological syndrome or
pattern that occurs in an individual and that is typically associated with either a painful symptom
(distress) or impairment in one or more important areas of functioning (disability). In addition, there is
an inference that there is a behavioral, psychological, or biological dysfunction” and that this
“dysfunction” is reflected in the relationship between the individual and society.
In addition, each “mental disorder” is behaviorally delineated by “diagnostic criteria” which attempt to
define a given “mental disorder.”
Although the concepts of “mental disorder” and of “diagnostic criterion” may have some merit, a
particular “mental disorder” and/or a particular “criterion” may have very little validity and/or reliability
in the context of an “unknown” etiology (causes). That is, the existence, the cause, the verifiability, and
the discreteness of a given “mental disorder” (and its associated criteria) may be absent when exposed in
the light of objective reality.
And to insure this lack of objective representation, the DSM’s habit of NOT reporting the validity (i.e.
“construct”) and the reliability coefficients of its “mental disorders” and “diagnostic criteria” has
hampered the mental health worker’s ability to evaluate and to apply the MCS structure in an objective
and a consistent manner.
To re-focus, in most respects, DSM-V is not much different than the three previous editions of DSM (i.e.
DSM-III, DSM-IV, and DSM-IV-TR). Still, some notable changes include the eliminating of “Asperger
syndrome” (299.80) as a distinct disorder; the loss of subtype classifications for various forms of
“Schizophrenia” (295.xx); the eliminating of the “bereavement exclusion” for “depressive disorders”
(300.4); the revised treatment and name change of “gender identity disorder” (302.xx) to “Gender
dysphoria”; and, the creation of a “new” gambling disorder.
Robert Leopold Spitzer, the chairperson of the task force for DSM-III, and Allen J. Francis, the
chairperson of the task force for DSM-IV, have been highly critical of the imposed secrecy of the initial,
DSM-V, developmental process. That is, their view is “that without transparency, any work’s credibility
can be challenged”: and, this happened starting with the historic and present criticisms of the “National
Institute of Mental Health” (NIMH). NIMH considers the DSM-V as a work of low validity because a
“symptom-focus system” (like in DSM) is imprecise and less productive while an “etiological-based
system” (like in biomedical research where “mental disorders” are assumed to be biological or genetic in
origin) is more precise and more productive.
(The NIMH is one of the 27 institutes and centers that comprise the “National Institutes of Health” [NIH].
And, the NIH, in turn, is an agency of the “United States Department of Health and Human Services”
[HHS]: and, the NIMH controls the funding of mental health research in the United States and
elsewhere.)
NIMH’s rejection of DSM-V will end the influence of the APA in matters of mental health research within
the United States. And, NIMH claims that it will publish its own diagnostic “manual” (i.e. the “Research
Domain Criteria”: RDoC) which will have significantly greater “construct” validity than DSM-V’s.
Thus, NIMH’s nosology [RDoC] will replace APA’s nosology [DSM-V] in all future, research efforts.
Both theoretical positions (at their extreme), that is, a “symptom-focused system” (DSMs) v. an
“etiological-focused system” (NIMH: incorporating genetics, imaging, cognitive science, etc. into
transforming diagnosis), have major validity and reliability issues.
That is, to conclude that a behavioral “symptom” is reflective of a specific “mental disorder” or that a
gene is the “cause” of a particular “mental disorder”, methodically speaking, is very difficult to
determine in the context of existing and ethical experimental designs. And since DSM and NIMH rarely
report “construct” validity and/or reliability data relative to their “methodological” endeavors, their
theoretical positions are more belief systems than they are science.
(A listing of the criticisms of DSM-V is the following: at less 70% of task force members have direct,
professional relationships with “Big” pharmacology; some task force members appear to be more
concerned about political and/or professional advancement than a more rigorous, DSM methodology;
the transformation of normal grief processes into a form of psychopathology; the refusal of task force
members to acknowledge the “biological underpinnings” of [some] “mental disorders”; the continued
use of the “Borderline” personality disorder label despite its extreme lack of “construct” validity; the
refusal of task force members to deal with the issue of high rates of “comorbidity” among “mental
disorders”; the continued use of the “not otherwise specified” category despite its conceptual
limitations ; the “overmedication” of “mental disorders” in general and the “overmedication” of children
in particular; and, finally, after a 19 year absence of a DSM revision (from 1994 to 2013), the DSM-V
reflects “little to a marginal” advancement in the context of a decreasing validities among “mental
disorders.)
And, as what was stated at the beginning of this e-article, more technical subjects are actively avoided in
order not to confuse and/or bore the reader. Still, APA and NIMH are poor advocates for an
understanding of the nature of “mental disorders.” They are also harming the American many with their
superficial understandings and invasive treatment strategies.
The path to a better understanding of the nature of psychopathology is through rigorous, experimental,
psychological research which emphasizes the validity and reliability of the “mental disorders” under
study. Furthermore, “either-or-paradigms” are rarely successful in understanding any subject under
study.
To summarize, some generalizations concerning the nature of “mental disorders” are the following: (1)
in the context of psychopathology, “mental disorders” are both genetic and behavioral (i.e. learned); (2)
less severe “mental disorders” are more behavioral than genetic in origin; (3) more severe “mental
disorders” are more genetic than behavioral in origin; (4) the vast majority of “mental disorders” are
more behavioral than genetic; (5) all “mental disorders” involve “anxiety” (300.02) and “depression”
(300.4) to varying degrees; (6) diagnostically and metaphorically, “anxiety” and “depression” are
“different sides of the same coin”; and, (7) experimental, psychological research should focus upon
“anxiety” and “depression” since both diagnostic categories reflect high validity and high reliability.
Finally, physicians and academic researches should spend more time in understanding and in practicing
the principles of the “Hippocratic Oath” in all its forms, especially its dictum “to do no harm” to the
American and the international many.
Thank you to “Hippocrates of Cos” for teaching one of the “truths of existence.”
And, thank you to all the psychologists and to all the physicians who know better.
Post Script: 6/25/2013
The “oligarchic”, “Citizens United”, Roberts high court (2005-present) has again “made law” concerning
the American many: it has decided to “strike down” the pre-clearance formula (i.e. “Section 4”) of the
Voting Rights Act of 1965 based upon its distorted, falsified, and purchased view that “voter suppressive
actions” no longer exist in the Act’s coverage areas.
Apparently, SCOTUS has not been aware of the “oligarchic” attempts to “true the vote” on the federal,
state, and local levels, especially since 2010. Or more directly, the current SCOTUS is a tool of powerful
corporate interests who are attempting to eliminate the inconvenience of the representative nature of
the American democratic system, especially of the Constitutional dictum of “one person, one vote.”
(Of course, “the one, one vote” dictum of the U.S. Constitution, originally, applied to only “white, male,
property owners.” Still, the “Founding Fathers’” structural correction for present and future cultural bias
was the U.S. Amendment process: a fact that some “Chief Justices” consistently deny and/or ignore by
expounding an “Originalists” philosophy of Constitutional law.)
Thus, Chief Justice “Citizens United” Roberts (who composed the majority opinion) and his “Originalists”
friends are liars “for all the ages.” Also, Roberts (among others on the court: that is, Scalia and Thomas)
is extremely unethical: please note his past anti-Voters Rights activity (i.e. as an official in the DOJ)
under the “oligarchic” President Ronald Wilson Reagan (1981-1989). Apparently, the “Chief Justice” is
unaware of the concept of “recusal” when “potential” biases exist!
Still, Roberts is correct about “Section 4” of the Voters Rights Act of 1965. The coverage areas’ formula
does require revision. But, it requires “revision” in the direction of its expansion with particular focus
upon the “voter suppression” states in all their “new”, Unconstitutional activities relative to the dictum
of “one person, one vote.”
Do Roberts and his follow “Originalists” not realize that future, Constitutional Amendments will involve
correcting the absurdity of such “oligarchic” rulings (and their “justifications”) as “Citizen United” (i.e.
“Corporations are people.”) and as not upholding previous, federal rulings concerning Shelby County v.
Holder (i.e. “Can you cite evidence of contemporaneous voter suppression activities?” And, current
“coverage jurisdictions” (which are subject to “pre-clearance”) are “out of date and no longer
necessary.).
Do they not realize that the American many know that the Roberts high court has ruled in favor of
“oligarchic”, corporate interests over 70% of the time since 2005?
(See e-articles “8”, “13”, “17”, “27”, “30”, “49”, “75”, “88”, and “102” on this website for more
information concerning SCOTUS and its “oligarchic” corruption.)
To hell with the “oligarchs” (“Big” healthcare, research, pharmacology, finance, academia, and “rightlibertarianism”) and their “familiars” (APA and its DSMs; NIMH and its proposed RDoC; the academic,
experimental, and clinical “psychologists” who know better but stay silent in the chaos of intimidation,
ambition, and greed; the mental health professionals who have used and will use the DSMs and the
proposed RDoCs, and the Roberts high court and its “merry band of ‘originalists’” who are attempting to
end representative democracy of the American many by expounding a Constitutional law philosophy of
“Originalism”),
Fromoneofthemany