Not so long ago, in the grand scheme of things, I went to see Professor Nancy McWilliams speak at Bryn Mawr College’s School of Social Work. I’ve mentioned her before, so I’m actually going to quote some of what I wrote (this was in April of 2007):
[McWilliams] helped to write a re-visioning (not a revision, yes?) of the Diagnostic and Statistical Manual that’s used for, well, diagnosing mental disorders — it’s a different idea, called the Psychodynamic Diagnostic Manual, which is focused more on (a) empirically-based psychodynamic theories of disorders and (b) etiological concerns. That is to say, to use her words: “The DSM leant itself to an understanding that the doctor is healthy and the patient is sick” — this is “attempting” to de-pathologize many of these syndromes, and to work in helping not just to remove the symptoms of disorders, but the causes (etiologies). As she put it, “No good physician would confuse the release of the symptoms of an illness with the release from the illness itself.”
In some ways, the PDM is a political document — it responds to the revisions of the DSM away from psychoanalytical thought (which has been argued as not-empirically-derived) by demonstrating collected empirical proof of psychoanalysis as effective. It’s intended to be useful to beginning therapists — not to insurance companies, who want a DSM ID number before paying for therapy. The PDM, instead, is meant to be used in a slightly different way: “Diagnosis goes on forever; it’s not a static process.” You keep on changing, reconsidering, as a patient speaks to you. Which is definitely interesting.
I go on, but this is the part I think is relevant today (although I do very much think the DSM has a place, because psychoanalytic thought, while interesting, is not known for its economy nor (not always) its scientific basis). Because today, The New York Times published an article by renowned ASD-researcher Simon Baron-Cohen talking about Asperger’s Syndrome, and its possible removal from the Diagnotistic and Statistical Manual (DSM), the book that I mention at the beginning there — which is used for all psychological diagnoses in the United States, and throughout much of the world. (There was a more detailed article that’s somewhat more objective, a week or so ago, if you’re intrigued.) I don’t actually think that Baron-Cohen (who, yes, is Sacha Baron Cohen’s cousin) makes too many good points in his article. But there are two which are excellent, and overshine the others:
1. There are decided consequences for removing Asperger’s from the DSM-V. Just imagining having someone tell me, “Nope, sorry, now you’re not Asperger’s, but maybe you’re PDD-NOS” strikes me as ridiculous.
2. The DSM is [ostensibly] based in empirical research. So do some, before acting. As of right now, we really don’t know whether Asperger’s is distinct from, or included within, ASDs.
3. He doesn’t quite say this, but rather implies it: the two other disorders which were removed from the DSM were removed because they were deemed to no longer be meaningful as a disorder. The first was homosexuality, more than forty years ago — deemed to not be a disorder at all. The second was neurosis, almost thirty years ago — deemed to be too general and indistinct, and not based in any research. Asperger’s is neither of these things. Although perhaps over-diagnosed (he doesn’t address this), Asperger Syndrome is certainly real, and the argument might be that it’s too specific. (Conversely, we might say that the comparison he’s making isn’t a good one — these two disorders were removed; Asperger’s would be “rebranded.”)
In any case, I found the topic worth sharing. I’m really fascinated by the idea of what gets to be in the DSM, and what is held out.
