January 19, 2009

DSM-V Controversies

dsmv controversies.jpg

If the front page of Psychiatric Times ran a story called DSM-V Controversies, and it contained this picture, what would you think the article would be about?

The picture certainly conjures up the concept of dogma.  Maybe you'd think it was about what belongs in the DSM and what does not; what constitutes disease, where does normal behavior stop and pathology begin?  Maybe it would be about the  larger questions of the appropriateness of basing a science on epidemiology and inference.

And certainly, those are the main controversies in psychiatry.  But this article doesn't mention any of those controversies. 

No.  The entire article is about conflicts of interests, financial ties of the committee members, and setting up rules to prevent the undue influence of "for profit" entities on psychiatry.  (As if psychiatry itself wasn't for profit?)

You're thinking, so what?

Be careful.  This this isn't an article about financial conflicts on interest in the creation of the DSM; it is an article about the controversies surrounding the DSM, of which this is the only one mentioned.

The difference is subtle, but absolutely vital.   The purpose of the article is to draw your attention away from the existence of the other more important controversies, and focus on the trivial one.  It  pretends to say, "here is one of the controversies, of which there are many others as well."  But by only hammering at the financial, it stops being an example and starts being a patsy.

This is what can be a called a morality play.  It doesn't require thought, only feeling and intuition, and elicits strong reactions and emotions.  All of this is to distract the masses from the fundamental problems, which require considerable intellectual sophistication and are anyways rarely settled, onto the more immediately rewarding moral opprobrium.  Debating about whether a guy who earned $20,000 in Glaxo speaker's fees should be allowed to weigh in on bipolar depression is a far easier and more satisfying argument than "what is bipolar depression?"

You say: surely you aren't suggesting that the authors of the DSM, and even Psychiatric Times, are engaged in a coordinated conspiracy to divert attention from the structural problems of psychiatry and on to meaningless discussions about payoffs and payouts?

No.  They're not trying to distract us, they are trying to distract themselves.  They're the parents of little Jimmy, protesting to the school administrators that that the words have been  changed to "We Wish You A Merry Holiday" so that they don't have to contend with the fact that those carols are the only religious instruction the parents have bothered to provide him. 

It is endless Congressional debates about corporate jets and executive pay, so that...