The DSM-V: Redefining Mental Illness

The history of psychology suggests that the process of defining and diagnosing a mental disorder might involve as much art and politics as it does science. We are reminded of this in a recent NY Times article, “Revising Book on Disorders of the Mind,” where we learn that medical experts are hard-at-work on a new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Many changes have been proposed for the DSM-5: some semantic (e.g., replacing the name “mental retardation” with the name “intellectual disability”) and others diagnostic (e.g., preventing the over-diagnosis of bipolar disorder in children by introducing a new illness called temper dysregulation disorder with dysphoria).

Of course, many philosophical issues arise in this context. One might wonder about the ethical, epistemic, and metaphysical ramifications of having mental disorders defined from on-high, as it were, by a relatively small number of medical experts. For instance, to what extent should the opinions of individual doctors and patients be bound by the standards and norms articulated in the DSM? Is it ever sensible for individual doctors or patients to buck the apparent authority of the DSM? And if so, under what conditions, and for what reasons? Or, more generally, what role should the DSM play in the way we understand the nature of mental illness, how to treat it, and how to live with it?

Related Articles:

Neuroethics: Ethics and the Sciences of the Mind
By Neil Levy , University of Melbourne
(Vol. 3, December 2008)
Philosophy Compass

Back to Basics in Bioethics: Reconciling Patient Autonomy with Physician Responsibility
By Antonio Casado da Rocha , University of the Basque Country
(Vol. 3, December 2008)
Philosophy Compass


Consciousness. Know it when you see it?

Because doctors are shunning the latest diagnostic techniques available, and going instead with their instincts, they’re misdiagnosing levels of consciousness. Experimenters found that of 44 patients diagnosed as being in a vegetative state, 18 were found to be in a minimally conscious state (so, capable of feeling pain). And of 41 patients diagnosed as being in a minimally conscious state, 4 had emerged from it without their doctors noticing.

When a patient is apparently comatose, the techniques of the phenomenologist are unavailable to the practicing MD. Never mind anti-behaviourist scruples, detecting consciousness is, in practice, a process of skilled behavioural observation.

For the findings go here. For an article on the findings in The Economist, go here.

Related articles:
£1.99 - small The Search for Neural Correlates of Consciousness
By Jakob Hohwy, Monash University
(Vol. 2, April 2007)
Philosophy Compass

£1.99 - small Theories of Consciousness
By Uriah Kriegel, University of Arizona/University of Sydney
(Vol. 1, February 2006)
Philosophy Compass