Cognition & Reality

Thursday, 11 November 2010

DSM-IV & Reality

I found the following paragraph in the course of my reading about “chemical imbalances.” I couldn’t have said it better: The diagnostic enterprise in psychiatry has transformed from nosological exploration into reifying patterns of psychoemotional distress, as if patients’ symptoms represent “real” diseases underneath. It is similar to the “computer metaphor” in cognitive psychology, which went by barely perceptible steps from cute heuristic into actively characterizing the mind as a computer, until ostensibly intelligent people were talking seriously about “storage,’ “retrieval,” “programming,” etc., as if they are authentic features of cognition.

On a still more fundamental level the use being made of the DSM-III and IV model of illness is at issue. DSM-II, perhaps out of respect for the underlying psychodynamics believed to be behind patient’s symptoms, tended to be loose about how to label patients. What was going on inside was more important. Beginning with DSM-III the decision to cluster symptoms into operational definitions that were consensually agreed upon was a proper step in trying to use scientific models. We were asked to buy into the principle, that regardless of theories about causality, there would be an agreed upon name for the collection of observed symptoms. But it has all too often deteriorated into a Platonic essence model, that is, a belief that there is a “real” version of the illness and actual illnesses are imperfect derivatives. If we truly understood etiology and pathogenesis this approach would be wonderful. It would mean we had arrived at the promised land. But short of this, DSM-IV can actually hinder therapeutic perspectives and treatment approaches. From “A Reevaluation of the Relationship between Psychiatric Diagnosis and Chemical Imbalances,” by Simon Sobo, M.D.

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