DSM-5: Redefining Who and What is Crazy

People like to think there is some finality in psychological assessments.  After all, saying that someone is nuts, schizo, retarded, loner, lame, or has a borderline personality disorder can solve a lot of problems when relating to people.  It has a lot to do with whether we take them seriously, pay attention to what they say, or even avoid them.  As opposed to whether we respect them, listen to their insights or even vote for them. 

The truth is that we have little to go on except that they mirror our prejudices – or not.  Human psychology exists as a continuum from one extreme to another. There are extremes to be sure. People who kill are extremely hard to tolerate.  People who steal always make me feel uncomfortable.  People who have an agenda are another group I dislike because, as nice as I may think they are, I know this is all leading to a time-share in Costa Rica or a baptism.  

Killers, robbers, con men (women) – unlikable personality types all.  Until I think about the Buddha, the broker who sold me the convertible, collateralized real estate annuity fund in Paraguay, or the president (whose name must not be spoken) who justified killing about 125 people in the invasion of the Caribbean nation of Grenada in 1983.  Evidently it’s hard to know who’s who. 

The “Diagnostic and Statistical Manual of Mental Disorders” ( DSM – history) is the sine qua non for calling someone ‘disordered’ in the USA – if it’s not in the book it doesn’t count.  But just when you think you’ve got someone pegged, the rules get changed.

For example, homosexuality used to be a bona fide mental disorder and we were justified in declaring gays a sick segment of society – and then the ‘shamans’ through much enlightened introspection determined that changes were needed and revisions were made (DSM-5 will be published in 2013).  

I partially jest when I refer to psychiatrists or priests as ‘shamans.’  I appreciate the insights of Freud, Jung, and others attempt to describe the nature of our cognition. They perform similar functions as shamans do in more primitive cultures, priests explain our fear of things that go bump in the night according to their dogma.  It’s all going to change again.

Update: http://tinyurl.com/7dom87l

 Personality disorders category is likely to be dramatically revised for next psychiatry textbook

 By Shari Roan, Los Angeles Times / For the Booster Shots blog

July 7, 2011, 12:05 p.m.

Several types of personality disorders will be dropped from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. But one disorder previously proposed for elimination — narcissistic personality disorder — will likely remain in the text.

The American Psychiatric Assn. announced Thursday that the framework for personality disorders in DSM-5 will be a “hybrid” model that is substantially different from how personality disorders are diagnosed currently. Under the new system, personality disorders will be aligned with particular personality traits and levels of impairment.

The committee working on the personality disorders chapter of the DSM-5, which is due to be published in 2013, has proposed six types of disorders: antisocial, avoidant, borderline, narcissistic, obsessive/compulsive and schizotypal. They have proposed dropping paranoid, histrionic, schizoid and dependent personality disorders.

However, to qualify for a diagnosis, a patient would have to have a high level of impairment in two areas of personality functioning — self and interpersonal. Patients would be assessed for how they view themselves and how they pursue their goals in life, for example, as well as how they get along with other people and whether they think about the consequences of their actions. The new model is less rigid than the existing diagnostic model. It is designed to reflect that behavior can change over time while personality traits tend to remain stable.

“In the past, we viewed personality disorders as binary. You either had one or you didn’t,” said Dr. Andrew Skodol, chairman of the DSM work group on personality disorders, in a news release. “But now we understand that personality pathology is a matter of degree.”

The American Psychiatric Assn. also announced that a public comment period on DSM-5 proposals has been extended through July 15.

About carlos

I'm a curious person, of reasonable intellect, "on the beach" (retired) and enjoying my interest in anthropology, language, civil rights, and a few other areas. I've been a hippie/student/aerospace tech writer in the '60s, a witness to the Portuguese revolution in the ‘70s, a defense test engineer and witness to the Guatemalan genocide in the '80s, and a network engineer for an ISP in the '90s. Now I’m a student and commentator until my time is up. I've spent time under the spell of the Mesoamerican pyramids and the sweet sound of the Portuguese language. I've lived in Europe, traveled in Brazil, Central America, Iceland, New Zealand, and other places. My preferred mode of travel is with a backpack and I eat (almost) anything local. Somehow, many of the countries I have been to have had civil unrest (for which I was not responsible). I'm open to correspond with anyone who might share my liberal, humanist interests. I live in San Buenaventura, California.
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