I read your summary of the working groups' proposals thinking "the next one is going to be about psychological factors... right?" Absolutely floored and somewhat aghast that you even need to make the suggestion for it to be its own section. It's a fundamental part of psychiatry!
I send my best wishes and condolences to the DSM redesigns, not necessarily in that order.
It may be an oversimplification to say that calling something a psychiatric disorder/illness vs NOT a disorder/illness has more social and political ramifications than is true for non-psychiatric medical conditions. It underlies the challenge of incorporating non-"experts" in the process. There are a good many people who consider themselves "survivors" of psychiatric care, and many of those flatly reject the existence of psychiatric disorders, much less the value of psychiatric care. If the APA intends to incorporate diverse views, it'll be tough - or impossible - to thread the needle of "all views are welcome, but our position is that there are conditions that we consider pathological and worthy of our treatment." Whether such conditions exist at all seems like a major fork in the road. I can imagine some of those ( eg madinamerica.com) yet again complaining that they've been disenfranchised once the new DSM says "yes, there are psychiatric illnesses." I think the APA needs to do more than offer lip service to engaging with that kind of thinking; it's not as if our treatment has been so spot-on that we can ignore this.
Psychiatrists are experts, if anyone is, in mental illness diagnosis and treatment, so society gives us some rights to have our views have more sway. How we do that with humility and not convey a sense that " we really don't know all that much" is another tough needle to thread.
Parenthetically, it has long griped me that the press likes to call the DSM 'the psychiatric bible," and if the DSM revisers get out in front of that from the outset, it'll help with balancing our expertise with our humility. I know it's a cute catchphrase, but we let it go too often.
This is a real opportunity to make the DSM more useful and respectable. There is a real risk of groupthink limiting the redesigners' effectiveness in doing so. I'm sure the work groups will have their own internal politics, and I hope that it'll be safe for the group members to say so when appropriate.
If I never see "NOS" again, they can declare victory!
I read your summary of the working groups' proposals thinking "the next one is going to be about psychological factors... right?" Absolutely floored and somewhat aghast that you even need to make the suggestion for it to be its own section. It's a fundamental part of psychiatry!
It is hard to believe! I had to flip through the AJP papers multiple times to make sure that it really is missing.
I send my best wishes and condolences to the DSM redesigns, not necessarily in that order.
It may be an oversimplification to say that calling something a psychiatric disorder/illness vs NOT a disorder/illness has more social and political ramifications than is true for non-psychiatric medical conditions. It underlies the challenge of incorporating non-"experts" in the process. There are a good many people who consider themselves "survivors" of psychiatric care, and many of those flatly reject the existence of psychiatric disorders, much less the value of psychiatric care. If the APA intends to incorporate diverse views, it'll be tough - or impossible - to thread the needle of "all views are welcome, but our position is that there are conditions that we consider pathological and worthy of our treatment." Whether such conditions exist at all seems like a major fork in the road. I can imagine some of those ( eg madinamerica.com) yet again complaining that they've been disenfranchised once the new DSM says "yes, there are psychiatric illnesses." I think the APA needs to do more than offer lip service to engaging with that kind of thinking; it's not as if our treatment has been so spot-on that we can ignore this.
I'm intrigued by the concept of epistemic arrogance. I came across a commentary about a subtle but useful alternative category of 'epistemic confidence." https://blog.apaonline.org/2019/06/03/against-epistemic-arrogance/
Psychiatrists are experts, if anyone is, in mental illness diagnosis and treatment, so society gives us some rights to have our views have more sway. How we do that with humility and not convey a sense that " we really don't know all that much" is another tough needle to thread.
Parenthetically, it has long griped me that the press likes to call the DSM 'the psychiatric bible," and if the DSM revisers get out in front of that from the outset, it'll help with balancing our expertise with our humility. I know it's a cute catchphrase, but we let it go too often.
This is a real opportunity to make the DSM more useful and respectable. There is a real risk of groupthink limiting the redesigners' effectiveness in doing so. I'm sure the work groups will have their own internal politics, and I hope that it'll be safe for the group members to say so when appropriate.
If I never see "NOS" again, they can declare victory!