Later this month, the American Psychiatric Association will unveil the fifth edition of its handbook of diagnoses, the Diagnostic and Statistical Manual of Mental Disorders. Fourteen years in the making, the D.S.M.-5 has been the subject of seemingly endless discussion.
But many critics overlook a surprising fact about the new D.S.M.: how little attention practicing psychiatrists will give to it.
This is because psychiatrists tend to treat according to symptoms.
So why the fuss over D.S.M.-5? Because of the unwarranted clout that its diagnoses carry with the rest of society: They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.
“They are the passports to insurance coverage, the keys to special educational and behavioral services in school and the tickets to disability benefits.”
As with any welfare service, people will find ways to abuse it. However, I find that to be a weak argument to justify a cohesive society is one without welfare services. It’s how culture and society provides and enforces these services that’s in question, not the presence of such services.
Entitlement is an overused word. Everybody in their own mind has entitlements of their own. The issue here is how, as a society, do we stop allowing the abuse of services by some while pragmatically serving those in true need.
We know that mental ailments are dependent on numerous complex factors, and yet, because of this system, we are simplifying a complex situation, this will not help patients!
The sad thing about the DSM-5 is that mental health counselors probably don’t think there exists such a thing as a mentally-healthy person who could not benefit from counseling. That may be true, but their goal is to make this type of wellness counseling paid for by insurance.
Tara: I think you are right about stopping the abuse of entitlement services, but how would you propose this to be done? It would require so much regulation and that requires more spending and assumes the regulations would be fair and effective.
I feel like this is the only way to reimburse for cases as complex as mental ailments! Even though the system has its flaws, it still introduces some form of organization to it.
To me the following statement is worrying: Insurance companies cover services only if there is a diagnosis. Yet, the suffering of a patient who doesn’t have the symptoms required to qualify for a diagnosis is no less real and no less worthy of professional attention.
I know that my insurance doesn’t cover psychiatrist visits precisely because it is hard to measure the practice and the outcome of treatments.
“Simply naming a mental illness does not necessarily point the way to effective treatment. This is why patients often qualify for more than one diagnosis, and why many have poor responses to medications.”
This happen far too many times and really can be a pain to find the proper treatment.
Unfortunately, I don’t think psychiatry will become an exact science any time soon.
Hah, Wasif — then why do headshrinkers get so upset when you ask them about practicing the subjective sciences?
Don’t they have one of those decision trees like the LPNs at the minute clinics yet?
Psychiatrists in disagreement. Never. It’s a good thing they only deal with brain chemistry.. or else I’d demand some sort of solidarity about best practices in the field.