When the world gets closer.

We help you see farther.

Sign up to our expressly international daily newsletter.

Already a subscriber? Log in .

You've reached your limit of one free article.

Get unlimited access to Worldcrunch

You can cancel anytime .


Exclusive International news coverage

Ad-free experience NEW

Weekly digital Magazine NEW

9 daily & weekly Newsletters

Access to Worldcrunch archives

Free trial

30-days free access, then $2.90
per month.

Annual Access BEST VALUE

$19.90 per year, save $14.90 compared to monthly billing.save $14.90.

Subscribe to Worldcrunch

Psychiatrists Not Crazy About The Revised Manual Of Mental Disorders

Avoiding cliches?
Avoiding cliches?
Fanny Jiménez and Christiane Löll

"This is the saddest moment in my 45-year career as a psychiatrist..." Dr. Allen Frances wrote this in a December blog post on the Psychology Today website. The reason was the approval by the American Psychiatric Association (APA) of the new edition of psychiatry’s bible – Diagnostic and Statistical Manual of Mental Disorders, or DSM – the handbook that doctors and psychotherapists worldwide use to determine mental illness.

In May, DSM-5 – the first revised edition since 1994 – is due to be published in the United States. And Allen Frances’s verdict about it has clout – he was the chair of the DSM-4 Task Force. His advice to clinicians, the press and the general public is to remain skeptical about DSM-5: “don’t follow it blindly.”

Over 1,500 experts from 39 countries have spent the last 14 years working on improving the classifications so that superfluous or imprecise diagnoses can be avoided and with them the wrong medication or therapy.

The new edition features new disorders, such Minor Neurocognitive Disorder – that can presage dementia, or eating and gambling addictions that for the first time link addiction to other sources than mind altering substances.

Other disorders have been left out – like Rett Syndrome, a neurodevelopmental disorder. The diagnostic criteria for many other illnesses have been changed. Autism for example will no longer be listed as a spectrum of many separate conditions so that, as of May, Asperger’s Syndrome will no longer exist.

All of this is the result of a great deal of hard work and discussion on the part of contributing experts, resulting in many different drafts of the manual before the APA signed off on the latest edition. The subject of sex addiction was particularly controversial – at first it was going to be included among behavioral addictions, then as a whole new illness called hypersexual disorder, and finally it was dropped because scientific evidence to support it was too slim.

According to the APA, the number of mental illnesses in the new edition remains the same and there are only a few fundamental changes. However, critics maintain that some diagnoses have been watered down and that changes are not based on sufficient scientific evidence.

These experts fear that DSM-5 will turn many healthy individuals into patients, and will limit treatment of certain diagnoses like autism. Fred Volkmar of Yale University estimates that only 60% of those who would get an autism diagnosis today will get it in the future.

Frances agrees that with the exception of autism, all the changes in the new edition will turn the “current diagnostic inflation into diagnostic hyperinflation” – something that could have dire consequences, given the global importance of the manual.

Temper tantrums as mental disorder

"The DSM is the standard reference book worldwide; research and treatments are based on it. It is also used as a reference in court cases and by insurance companies," says Winfried Rief of the University of Marburg, one of the experts involved in producing DSM-5. German doctors also use the World Health Organization (WHO) International Classification of Diseases, the present edition of which (ICD-10) is due for an overhaul in 2015.

Hans-Ulrich Wittchen of Dresden’s University of Technology, who also worked on DSM-5, says he does not believe the new version will lead to increased numbers of diagnoses. "No changes are to be expected because the criteria were only changed marginally," he explains, adding that "even the new disorders will most likely not impact the total number of patients because most patients suffering from conditions added to DSM-5 usually have other disturbances listed in earlier editions."

But Frances is adamant that the new edition is going to bring with it a dramatic rise in the number of mental illness diagnoses, particularly – as “painful experience” with previous editions has shown – if anything in the diagnostic system is abused and turned into a “fad.”

The conflict demonstrates just how difficult it is to classify mental illness. A case in point is what DSM-5 lists as "disruptive mood dysregulation disorder" in children. On Frances’s list of the ten worst changes from the previous edition, this condition is ranked number one.

According to the APA, this diagnosis applies to children who display disruptive patterns three or more times a week for at least a year, and it is supposed to help check over-diagnosis and over-treatment of bipolar disorder in children. But Frances charges that what it amounts to is turning “temper tantrums into a mental disorder.” His own book, SAVING NORMAL: The Battle at the Boundary of Psychiatryis due out around the same time as DSM-5.

What is clear is that there are no definitive answers – or answers that will satisfy everyone. Says Wittchen: "Diagnostics never end – many problems have yet to be resolved because we don’t yet know enough about how the brain works. Breakthroughs in neurobiological research could mean a whole new set of diagnoses. And then we get to start from scratch.”

You've reached your limit of free articles.

To read the full story, start your free trial today.

Get unlimited access. Cancel anytime.

Exclusive coverage from the world's top sources, in English for the first time.

Insights from the widest range of perspectives, languages and countries.


Shame On The García Márquez Heirs — Cashing In On The "Scraps" Of A Legend

A decision to publish a sketchy manuscript as a posthumous novel by the late Gabriel García Márquez would have horrified Colombia's Nobel laureate, given his painstaking devotion to the precision of the written word.

Photo of a window with a sticker of the face of Gabriel Garcia Marquez with butterfly notes at Guadalajara's International Book Fair.

Poster of Gabriel Garcia Marquez at Guadalajara's International Book Fair.

Juan David Torres Duarte


BOGOTÁ — When a writer dies, there are several ways of administering the literary estate, depending on the ambitions of the heirs. One is to exercise a millimetric check on any use or edition of the author's works, in the manner of James Joyce's nephew, Stephen, who inherited his literary rights. He refused to let even academic papers quote from Joyce's landmark novel, Ulysses.

Or, you continue to publish the works, making small additions to their corpus, as with Italo Calvino, Samuel Beckett and Clarice Lispector, or none at all, which will probably happen with Milan Kundera and Cormac McCarthy.

Another way is to seek out every scrap of paper the author left and every little word that was jotted down — on a piece of cloth, say — and drip-feed them to publishers every two to three years with great pomp and publicity, to revive the writer's renown.

This has happened with the Argentine Julio Cortázar (who seems to have sold more books dead than alive), the French author Albert Camus (now with 200 volumes of personal and unfinished works) and with the Chilean author Roberto Bolaño. The latter's posthumous oeuvre is so abundant I am starting to wonder if his heirs haven't hired a ghost writer — typing and smoking away in some bedsit in Barcelona — to churn out "newly discovered" works.

Which group, I wonder, will our late, great novelist Gabriel García Márquez fit into?

Keep reading...Show less

The latest