Review

Philosophy, Ethics, and Humanities in Medicine

, 7:3

Open Access This content is freely available online to anyone, anywhere at any time.

The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis

  • James PhillipsAffiliated withDepartment of Psychiatry, Yale School of Medicine Email author 
  • , Allen FrancesAffiliated withDepartment of Psychiatry and Behavioral Sciences, Duke University Medical Center
  • , Michael A CerulloAffiliated withDepartment of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine
  • , John ChardavoyneAffiliated withDepartment of Psychiatry, Yale School of Medicine
  • , Hannah S DeckerAffiliated withDepartment of History, University of Houston
  • , Michael B FirstAffiliated withDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric Institute
  • , Nassir GhaemiAffiliated withDepartment of Psychiatry, Tufts Medical Center
  • , Gary GreenbergAffiliated withHuman Relations Counseling Service
  • , Andrew C HinderliterAffiliated withDepartment of Linguistics, University of Illinois
    • , Warren A KinghornAffiliated withDepartment of Psychiatry and Behavioral Sciences, Duke University Medical CenterDuke Divinity School
    • , Steven G LoBelloAffiliated withDepartment of Psychology, Auburn University Montgomery
    • , Elliott B MartinAffiliated withDepartment of Psychiatry, Yale School of Medicine
    • , Aaron L MisharaAffiliated withDepartment of Clinical Psychology, The Chicago School of Professional Psychology
    • , Joel ParisAffiliated withInstitute of Community and Family Psychiatry, SMBD-Jewish General Hospital, Department of Psychiatry, McGill University
    • , Joseph M PierreAffiliated withDepartment of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLAVA West Los Angeles Healthcare Center
    • , Ronald W PiesAffiliated withDepartment of Psychiatry, Tufts Medical CenterDepartment of Psychiatry, SUNY Upstate Medical University
    • , Harold A PincusAffiliated withDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, Division of Clinical Phenomenology, New York State Psychiatric InstituteIrving Institute for Clinical and Translational Research, Columbia University Medical CenterNew York Presbyterian HospitalRand Corporation
    • , Douglas PorterAffiliated withCentral City Behavioral Health Center
    • , Claire PounceyAffiliated withCenter for Bioethics, University of Pennsylvania
    • , Michael A SchwartzAffiliated withDepartment of Psychiatry, Texas AMHSC College of Medicine
    • , Thomas SzaszAffiliated withDepartment of Psychiatry, SUNY Upstate Medical University
    • , Jerome C WakefieldAffiliated withSilver School of Social Work, New York UniversityDepartment of Psychiatry, NYU Langone Medical Center
    • , G Scott WatermanAffiliated withDepartment of Psychiatry, University of Vermont College of Medicine
    • , Owen WhooleyAffiliated withInstitute for Health, Health Care Policy, and Aging Research, Rutgers, the State University of New Jersey
    • , Peter ZacharAffiliated withDepartment of Psychology, Auburn University Montgomery

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 I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. 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.