As someone who worked on the DSM-IIIR version of Psychiatry’s diagnostic bible, I may not be entitled to it, but certainly have some personal opinions about how the diagnostic system has evolved. I was provoked to write this post by a recent presentation at an MUSC psychiatry grand rounds by Paul McHugh one of the deans of psychiatry, and a Professor at Johns Hopkins University.
When I worked on that earlier version, my primary contribution was as a member of the committee who forged many of our current conceptualizations of the childhood-specific psychiatric disorders. The committee was comprised largely of respected academicians, and our decisions were informed by some of the latest research. In that climate, we were all hopeful that this process, as it evolved, would bring our research into closer contact with the real problems we addressed.
However, as Dr McHugh points out, the DSM has been rather unsuccessful, as a research catlyst and has contributed little to our progress in the field. (It has, however, through its royalties, been a goldmine for the professional organziation). The likely reason it has not been useful in research is that it is a simplistic “field guide” which requires no more than a hobbyist’s understanding to be used be used by amateurs and professionals alike. The kinds of in depth, thoughtful training that once characterized psychiatry and psychology, has given way to crib sheet learning.
When I studied personality in my graduate psychology class, we had to read and understand 38 books. Now its less rigorous. From all of the last ten interviews I conducted for psychology jobs — with newly minted psychologists — only one was able to actually discuss what personality was, and most did not even have a clue, muchless 38 books-full of knowledge.
Diagnosis needs to move in a more useful and less superficial direction I believe we can have reliable diagnoses that are also useful. Let’s move to that playing field, and score a few touchdowns.