Wednesday, February 10, 2010

An update on Drug Sales Manual V (DSM-V). And: "Intellectual Disability" is the new MR.

"Big changes proposed in psychiatric diagnoses"

OK, I am getting old. When I first began my involvement in mental health/mental illness/psychological/psychiatric treatment, the diagnostic code book was the DSM-III, yellow-and-green.

I had no idea what significance was involved as DSM-III was succeeded by DSM-III-R - blue-with-yellow. But that blue cover seemed so much more sophisticated.

Then came DSM-IV - maroon - wow - did that look like burnished leather! next to the blue.

Then DSM-IV-TR: the silver! Distinguished.

Now: DSM-V? Through my experiences, I understand what the DSM is and is not; what it does and does not do. I lyself am not looking for some great advancements in mental health treatment no matter what color this book will be.

I do agree with critics out there that we are likely to see more diagnoses, including more things that will make us wonder if these things really fall into the range of "mental disorders" (the DSM's term).

I certainly believe that there is heavy influence from Big Pharma to use any new diagnosis as an opportunity to give physicians an easy answer: pills. Pills that happen to be under patent. The conflicts of interest noted regarding the people developing DSM-V surely make it clear that big money is at stake.

I am getting older and more cynical.

Another sign I am getting older: how we label problems of lower-intellectual-functioning is again changing. The history books say the old terms were "imbecile, "moron," etc. At the time, did these sound as benign as I believe "mentally retarted," or "mental retardation," sounds to me now?

Does MR sound old? Is "intellectual disability" better?

In the future, will "intellectual disability" sound bad, like it sounds bad to describe a physically handicapped person as "crippled" sounds? As bad as "moron" sounds?

Are we getting better at naming these problems, or do we just need to periodically update our terms, as the current term collects a pejorative, innacurate connotation? Should we figure out what the lifetime of each term is? Should focus groups be done regularly to monitor the point when "intellectual disability" changes from sounding OK to sounding like an insult?

We will see.

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