A friend and I were discussing the issue when she made a remarkable comment. It was one of those insights that, as soon as you hear it, the lightbulb goes on.
Having a several decades-long career as a publisher, independent bookstore owner, and book lover made her remark even more startling.
“It seems to me,” she said, “that some documents are just not meant to be in print form.”
Huh? was my first reaction. Then I realized: she’s right.
As I pondered her statement, I realized I tend to agree. The static form of a print book no longer serves the function of being a useful diagnostic tool. Several arguments point to this conclusion.
As we’ve already seen in the discussions here at Psych Central (including my previous post on the topic, On Scrapping the DSM and Stories, Eh?), there is an emerging school of thought that contraindicates the efficacy of a written tome. It calls for a tomb for the tome (sorry, I couldn’t resist). The tome, that is, in its present form.
The new thinking suggests that a disembodied grab-bag of traits or symptoms falls short of describing an individual’s lived experience of ADHD (or any other mental health condition).
Perhaps it’s the pendulum swinging, but there’s a shift away from the Western approach of dissecting an individual into component bits. More of us are espousing the merits of a more holistic approach in every facet of life, considering the composite of mind, body, emotions, and spirit as an integrated, functioning system. If one of these is affected, the organism is affected in its entirety. There is mounting evidence to suggest that moods affect physiology and so on.
A more encompassing approach to diagnosis, one which would recognize different paradigms, would take into account an individual diagnostician’s perspective. Just as the creationists must live in harmony with the…er… evolutionists, for the time being, perhaps the DSM-5 could reflect both points of view. And perhaps both visions would be better presented in a more versatile, accommodating form.
Go with the flow
It’s the DSM’s job to identify dis-ease arising from non-neurotypical brains (minds?). If the goal of diagnosis is to alleviate widespread suffering, then it would seem to me to be counter-productive to codify into book form a snapshot of knowledge on a given day: specifically, the day the thing goes to print. Like a river, a more fluid form of a diagnostic tool would be much better-suited to serve its function. Like the river, the diagnostic tool will always remain, but the flow of new information could be injected as it arises.
Emerging brain research
With the advances in neuroimaging, ongoing research into the brain’s biochemistry, ideas such as epigenetics, to name a few recent and ongoing areas of study, surely a static hunk of bound paper, scheduled for updates only every few years, is an antiquated form that no longer serves its function in the case of the DSM.
Is an olive without a pimento still an olive?
I have no idea what this new form would look like, I’m just throwing the concept out there. Obviously, we don’t want an open Wikipedia-type platform where anyone and everyone can throw their ideas at the wall and have them stick. There would have to be some sort of base credentials, but I like the idea of a more collaborative approach, incorporating philosophical, anthropological, cultural, and other concepts into the mix. (I had a brilliant analogy here of tweezing a pimento from an olive, and considering it as representative of the olive itself, but then I got lost and realized I’m just getting hungry…)
As I’m devolving into hunger pangs, I leave this concept open, and throw the discussion over to you.
One more thing
Oh, ya. One more thing. My brainiac publisher friend would also like to know, What the heck is up with the “5”? Have we suddenly forgotten our Roman Numerals? I admit that when I first saw the Arabic “5,” the writer/proofreader in me aligned with my friend the publisher in balking at an inconsistency of this magnitude. Then again, we’re not the ones who’ll be making the diagnoses, so I guess we’ll just have to lump it.
As for an explanation, I did find a brief reference to the change from Alan F. Schatzberg, M.D.:
One of the key differences between DSM-IV and DSM-5 (yes, we are now using the Arabic number system to allow for ongoing brief updates as the science progresses)…
From: DSM-5: The Next Steps Begin, Psychiatric News, American Psychiatric Association, March 05, 2010,Volume 45 Number 5 page 3-3
…which begs the question which is at the heart of this post: should form follow function? Perhaps there is a more useful delivery modality for the DSM, especially when updates are anticipated (and why presume they’ll be “brief”?…)
Ok, two more things
In my initial post on the proposed DSM-5, I raised some specific questions. I think most, if not all of them have been answered by the ensuing comments and posts, except one: it is clear that the option of offering input to the various committees responsible for penning the new version is now long expired. It will be interesting to see what we end up with once the dust settles on the new DSM-5, for better or worse.