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Phillips J, Frances A, Cerullo MA, Chardavoyne J, Decker HS, First MB, Ghaemi N, Greenberg G, Hinderliter AC, Kinghorn WA, LoBello SG, Martin EB, Mishara AL, Paris J, Pierre JM, Pies RW, Pincus HA, Porter D, Pouncey C, Schwartz MA, Szasz T, Wakefield JC, Waterman GS, Whooley O, Zachar P. The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis. Philos Ethics Humanit Med 2012; 7:9. [PMID: 22621419 PMCID: PMC3403926 DOI: 10.1186/1747-5341-7-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Accepted: 05/23/2012] [Indexed: 06/01/2023] Open
Abstract
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions. Part 2 took up the second two questions. Part 3 now deals with Questions 5 & 6. Question 5 confronts the issue of utility, whether the manual design of DSM-III and IV favors clinicians or researchers, and what that means for DSM-5. Our final question, Question 6, takes up a concluding issue, whether the acknowledged problems with the earlier DSMs warrants a significant overhaul of DSM-5 and future manuals. As in Parts 1 & 2 of this article, the general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
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Affiliation(s)
- James Phillips
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Allen Frances
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
| | - Michael A Cerullo
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, 260 Stetson Street, Suite 3200, Cincinnati, OH, 45219, USA
| | - John Chardavoyne
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Hannah S Decker
- Department of History, University of Houston, 524 Agnes Arnold, Houston, 77204, USA
| | - Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Nassir Ghaemi
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - Gary Greenberg
- Human Relations Counseling Service, 400 Bayonet Street Suite 202, New London, CT, 06320, USA
| | - Andrew C Hinderliter
- Department of Linguistics, University of Illinois, Urbana-Champaign, 4080 Foreign Languages Building, 707S Mathews Ave, Urbana, IL, 61801, USA
| | - Warren A Kinghorn
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 508 Fulton St, Durham, NC, 27710, USA
- Duke Divinity School, Box 90968, Durham, NC, 27708, USA
| | - Steven G LoBello
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
| | - Elliott B Martin
- Department of Psychiatry, Yale School of Medicine, 300 George St, Suite 901, New Haven, CT, 06511, USA
| | - Aaron L Mishara
- Department of Clinical Psychology, The Chicago School of Professional Psychology, 325 North Wells Street, Chicago, IL, 60654, USA
| | - Joel Paris
- Institute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University, 4333 cote Ste. Catherine, Montreal, H3T1E4, QC, Canada
| | - Joseph M Pierre
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, 760 Westwood Plaza, Los Angeles, CA, 90095, USA
- VA West Los Angeles Healthcare Center, 11301 Wilshire Blvd, Los Angeles, CA, 90073, USA
| | - Ronald W Pies
- Department of Psychiatry, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Harold A Pincus
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
- Irving Institute for Clinical and Translational Research, Columbia University Medical Center, 630 West 168th Street, New York, NY, 10032, USA
- New York Presbyterian Hospital, 1051 Riverside Drive, Unit 09, New York, NY, 10032, USA
- Rand Corporation, 1776 Main St Santa Monica, California, 90401, USA
| | - Douglas Porter
- Central City Behavioral Health Center, 2221 Philip Street, New Orleans, LA, 70113, USA
| | - Claire Pouncey
- Center for Bioethics, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA
| | - Michael A Schwartz
- Department of Psychiatry, Texas A & M College of Medicine, 4110 Guadalupe Street, Austin, Texas, 78751, USA
| | - Thomas Szasz
- Department of Psychiatry, SUNY Upstate Medical University, 750 East Adams St, #343CWB, Syracuse, NY, 13210, USA
| | - Jerome C Wakefield
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
- Department of Psychiatry, NYU Langone Medical Center, 550 First Ave, New York, NY, 10016, USA
| | - G Scott Waterman
- Department of Psychiatry, University of Vermont College of Medicine, 89 Beaumont Avenue, Given Courtyard N104, Burlington, Vermont, 05405, USA
| | - Owen Whooley
- Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson St, New Brunswick, NJ, 08901, USA
| | - Peter Zachar
- Department of Psychology, Auburn University Montgomery, 7061 Senators Drive, Montgomery, AL, 36117, USA
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