Such a fun read. I'd be so burnt out without this newsletter and the exposure to thoughtful commentary on the field I think about (and am part of) daily.
Fantastic interview and many rich points. The issue of the social roles making the DSM being "too big to fail" is interesting and ripe for more discussion. Speaking as someone who's done forensic training and continues to do some legal work, I'm not sure the DSM is actually essential for the law. The law is very clearly not bound to psychiatric nosology. This was shown quite sadly and firmly by Kansas v Hendricks (and I was just lecturing about this yesterday to the Columbia fellows), which showed that a state can make up its own shaky definition of "mental abnormality" and not be bound to the opinion of the psychiatric community. On a smaller scale there have always been forensic experts opining on unconventional diagnoses (e.g., "battered woman syndrome"). So I'd imagine is that without the DSM, what you would have is a range of more ideosyncratic opinions, some "rogue" and low-quality, but others probably perfectly reasonable, and perhaps some enhanced by being less bound to the DSM. Would that be a net positive or negative? Hard to say, but cynically I do tend toward the latter.
All that said, re: insurance reimbursement, billing, also policy issues like parity, I do think the "too big to fail" idea is correct!
Such a fun read. I'd be so burnt out without this newsletter and the exposure to thoughtful commentary on the field I think about (and am part of) daily.
Fantastic interview and many rich points. The issue of the social roles making the DSM being "too big to fail" is interesting and ripe for more discussion. Speaking as someone who's done forensic training and continues to do some legal work, I'm not sure the DSM is actually essential for the law. The law is very clearly not bound to psychiatric nosology. This was shown quite sadly and firmly by Kansas v Hendricks (and I was just lecturing about this yesterday to the Columbia fellows), which showed that a state can make up its own shaky definition of "mental abnormality" and not be bound to the opinion of the psychiatric community. On a smaller scale there have always been forensic experts opining on unconventional diagnoses (e.g., "battered woman syndrome"). So I'd imagine is that without the DSM, what you would have is a range of more ideosyncratic opinions, some "rogue" and low-quality, but others probably perfectly reasonable, and perhaps some enhanced by being less bound to the DSM. Would that be a net positive or negative? Hard to say, but cynically I do tend toward the latter.
All that said, re: insurance reimbursement, billing, also policy issues like parity, I do think the "too big to fail" idea is correct!