In evaluating dysfunction or illness, we have long followed the seemingly straightforward model of diagnose, treat, evaluate, iterate.
However, diagnosis has long been the secret — or not so secret — Achilles heel of the psychiatric establishment. Many philosophic issues arise, issues of cultural relativism, ethical issues of financial interests in pharmaceuticals, to name a few. These are issues that ‘by the book’ psychiatrists frequently dismiss as ‘merely philosophical.’ Indeed, it’s been a relatively long time since Freud or Jung were taken entirely seriously by the establishment doling out the meds. ”By the book.” What is “the book”?
Since DSM-III (American Psychiatric Association 1980), disorders have been defined in terms of syndromes—that is, clusters of symptoms that covary together (see the section following, titled “Need to Explore the Possibility of Fundamental Changes . . .”). …
The major focus of field trials for DSM-III was establishing the reliability with which multiple clinicians could come to the same diagnostic conclusions when presented with a patient’s expressed signs and symptoms. In this manner, it was possible to demonstrate that an atheoretical, descriptive approach could result in a reproducible diagnosis in multiple clinical and cultural settings. Following the publication of DSM-III in 1980, data began to emerge by 1983 from some new studies that were not consistent with the syndromal definitions in DSM-III. … A Research Agenda for DSM V.
For those that continue to see the DSM as a gold standard in this regard, we don’t need to recall the times when homosexuality was considered a mental illness. There are remain plenty of conceptual holes with the schema of the DSM 5. In fact, the NIH has gone so far as to disavow the DSM V as a successful diagnostic standard.