Review
The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis
1 Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
2 Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
3 Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
4 Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
5 Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
6 Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
7 Human Relations Counseling Service, 400 Bayonet Street Suite 202, New London, CT, 06320, USA
8 Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707S Mathews Ave, Urbana, IL, 61801, USA
9 Duke Divinity School, Box 90968, Durham, NC, 27708, USA
10 Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
11 Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
12 Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, H3T1E4, QC, Canada
13 Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
14 VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
15 Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
16 Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
17 New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
18 Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
19 Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
20 Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
21 Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, Texas, 78751, USA
22 Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
23 Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
24 Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont, 05405, USA
25 Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
Philosophy, Ethics, and Humanities in Medicine 2012, 7:9 doi:10.1186/1747-5341-7-9
Published: 23 May 2012Abstract
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM – whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
