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#Darwin project hacks manual
During the First World War it was used for assessing army recruits, perhaps the first time it was put to diagnostic use.Īlthough the manual is American, it is much used elsewhere, despite the fact that the International Classification of Diseases, drawn up under the auspices of the World Health Organisation in Geneva, is usually seen as the official manual, if there is one. It was soon incorporated into the decennial US census. In a sense, the manual has its origins in 1844, when the American Psychiatric Association, in the year of its founding, produced a statistical classification of patients in asylums. For that one requires a standardised classification. Why is this a ‘statistical’ manual? Because its classifications can be used for studying the prevalence of various types of illness. There is another quite different bureaucratic use. It is also required for the universal health insurance plans provided in Canadian provinces. The coding is required both by American private insurers and by Medicare. For example, opening the book at random, I find 308.3 for Acute Stress Disorder. Everyone in North America who hopes their health insurance will cover or at least defray the cost of treatment for their mental illness must first receive a diagnosis that fits the scheme and bears a numerical code. The more interesting question is who needs the DSM anyway? First of all, bureaucracies. Who needs the 947 pages of the DSM-5? All that most consumers need is the DSM-5 Diagnostic Criteria Mobile App. I shall discuss none of these important issues, and will try to be informative and even supportive until the very end of this piece, where I address a fundamental flaw in the enterprise. More and more kinds of behaviour are now being filed as disorders, opening up vast fields of profit for drug companies. On a quite different score, Allen Frances, the chief editor of DSM-IV, has for years been blogging his criticisms of the modifications leading to DSM-5. More generally, it opposes the biomedical model of mental illness, to the exclusion of social conditions and life-course events. In mid-May an onslaught was delivered by the Division of Clinical Psychology of the British Psychology Society, which is sceptical about the very project of standardised diagnosis, especially of schizophrenia and bipolar disorders. I want to talk about the object as a whole – about the wood – and will seldom mention particular diagnoses, except when I need an example. To invoke the cliché for the first time in my life, most critics attended to the trees (the kinds of disorder recognised in the manual), but few thought about the wood. Most of it has concerned individual diagnoses and the ways they have changed, or haven’t. Hence its publication has been greeted by a flurry of discussion, hype and hostility across all media, both traditional and social. The DSM is the standard – and standardising – work of reference issued by the American Psychiatric Association, but its influence reaches into every nook and cranny of psychiatry, everywhere. The new edition of the DSM replaces DSM-IV, which appeared in 1994.