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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 4 of 4. This is the beginning of the thread.
Posted by alexandra_k on July 16, 2013, at 1:43:51
I just saw it. It is quite beautiful, i think. I mean, the purple is alright, but it felt lighter, somehow. More succinct. More careful. Or maybe that is just me. Because it's grip is loosening. Or maybe there is an alteration in tone... A kind of awareness that they don't really want the burden of responsibility / power that they used to have / that others have been battling to take from them. Or maybe it is differently type-setted so it feels lighter. Less white space. Smaller print.
I'm most interested in the introductory blurb and the culture bound stuff in the appendices... But I thought the introductory blurb was beautiful in its simplicity. Finally... After the ugly disjunctive definition of the DSM-IV we have the comparatively elegant:
'A mental disorder is a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.'
- usually associated with distress or disability
- not culturally sanctioned (e.g., grieving death)
- not merely socially deviant or conflicts between individual and societyThey bloody gave Wakefield his 'inner dysfunction'. I have grudging admiration, I suppose... He did bang on... There might be something to it...
I think I have that studies too much one in the appendix. I failed to adapt to tech because I think / study to much. Ahaha.
I am concerned about the their explicitly trying to loosen the link between treatment and disorder, and legal / moral responsibility and disorder. I mean... Well... What would a dx system that was useful for those enterprises look like? Wouldn't the treatment one have every bit as much a claim to be THE important manual for clinical practice?
Anyway... Good on them for raising these issues.
I think they did well, actually. But maybe I'm full of compliments feeling vulnerable about my own ability to contribute anything of value whatsoever...
Posted by alexandra_k on July 17, 2013, at 0:11:44
In reply to DSM-5, posted by alexandra_k on July 16, 2013, at 1:43:51
ah, no they didn't. they allow the dysfunction can be behavioral as they did before.
they moved the bump. they made the definition sound so much simpler... but the bump has reappeared in the section on forensic and their attempt to divorce dx from tx.
hrm...
hrm...
hrrrrrrm...
Posted by Dinah on July 17, 2013, at 8:53:50
In reply to DSM-5, posted by alexandra_k on July 16, 2013, at 1:43:51
I have heard nothing good about the DSM-5, but haven't looked at it myself. I wasn't overly fond of the DSM-4 either.
I resent being forced into a mold, and the doctors who live and breathe by the DSM tend to do that.
Posted by alexandra_k on July 18, 2013, at 4:58:23
In reply to Re: DSM-5 » alexandra_k, posted by Dinah on July 17, 2013, at 8:53:50
> I have heard nothing good about the DSM-5, but haven't looked at it myself. I wasn't overly fond of the DSM-4 either.
>
> I resent being forced into a mold, and the doctors who live and breathe by the DSM tend to do that.Yes. I imagine being on the task-force is a fairly thankless task... A lot of people are going to be made unhappy, no matter what you do.
The beginning blurb is the caveats...
This time... They said they tried to be responsive to consumer feedback. I guess that was about complaints that were made about judgements like 'manipulativeness' etc. They don't specify... That is a hard one, though, since the criteria are supposed to be objective and thus not particularly amenable to lobby group pressure (I don't know that they acknowledge the influence of that for the removal of homosexuality or the inclusion of post-traumatic stress for war veterans).
They have a significant speel on forensics... How even when the criterion requires diminished cognitive capacity (for instance) that doesn't mean there is diminished cognitive capacity in the legal sense. They have a speel on how diagnosis doesn't imply anything important for law (with respect to intent etc or with respect to best treatment e.g., drugs and psych ward or prison). But that is a tricky fine line because why have a diagnostic handbook if the diagnoses are not relevant for determining best treatment? Caught between a rock...
They say that the diagnostic categories don't imply much for treatment. Thus there may be people requiring treatment or who would benefit from treatment who don't meet criteria. They don't mean to imply they shouldn't be treated. And conversely people might meet criteria but that doesn't imply they should be treated.
So... What does dx MEAN, again??
Oh dear...
They need something, though...
Or... Do they?
With the translation between WHO's ICD Index... Why do they need a separate dx manual at all???
The NIMH (National Institute of Mental Health) has provided alternative areas to focus research on. They are fairly sensible areas... From an evolutionary / developmental point of view... Broad, general... I don't know... Promising...
Of course it is possible I'm not summarizing them particularly well.. Dense text to be sure and vague language is best for capturing vague phenomena but it makes comprehension tricky...
This is the end of the thread.
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