Maggie's Farm

Many have heard about the latest kerfuffle at the American Psychiatric Association, which has decided to eliminate Narcissistic Personality Disorder from their next DSM edition (the DSM V). They have also eliminated some other personality disorders.

I really do not care what those clinical researchers on those committees vote for or against, because their view of the world is not mine. 

The reason things like the DSM have little meaning to me is because their "diagnoses" have no internal validity (and, indeed, they focus more on consensual validity - meaning that docs can agree on a label - than internal validity, which they feel could be either unattainable, or too "theoretical"). Regardless of its origin, it all comes out in the DSM cookbook as "Anxiety Disorder, Panic Type" or something like that.

For example, let's say there are as many pathways to panic attacks as there are people who have this nasty symptom. Some of it might be inherited, some acquired, most some mix - and all embedded in a personality of a certain structure (which is our way of saying predictability).

This idea, I believe, is to make Psychiatry so "scientific" that the doc can then refer to the latest therapeutics manual and decide what medicine to offer. To my thinking, this is "pseudo-medical." Anxiety, in my view, is a symptom and not a "disorder." Analogous to a fever. Thus saying somebody has an Anxiety Disorder is not the end point of diagnosis - it's the beginning of a search for understanding.

What's the fever (or OCD or sex obsession or eating disorder) coming from? That's what I want to do the detective work on, one person at a time.

Docs like me prefer to work in depth, and find the DSM exasperatingly superficial and reductionistic.

The Last Psychiatrist discusses further: Narcissism Out Of The DSM-- And Into The Open