DSM-5: Where Do We Go From Here?

The publication of DSM-5 is a sad moment for psychiatry and a risky one for patients.

My recommendation for clinicians is simple. Don't use DSM-5-there is nothing official about it, nothing especially helpful in it, and all the codes you need for reimbursement are already available for free on the Internet or in DSM-IV. New codes will go into effect in October 2014-but these will also be free online. Spending $199 on the DSM-5 white elephant makes no sense.

My advice to patients is more complicated and difficult to accomplish. Psychiatric diagnosis can be a turning point in your life, leading to great good if accurate, great harm if not. Take at least as much care in buying a diagnosis as when you buy a house or car. Become fully informed consumers, knowledgeable enough to challenge doctors who make quick or questionable diagnostic calls. Never accept a diagnosis or take pills that are prescribed after a brief evaluation. Always be prepared to ask lots of questions and expect common sense answers. If you don't get them, seek a second opinion. Make sure the diagnosis fits before you buy it.

Education and discussion will be the most powerful ways to mitigate the risks of DSM-5. The more people know about psychiatric diagnosis, the more safe, accurate, and useful it will be.

That's why I am so pleased that Thomas Nickel, PhD, Head of Continuing Education at Alliant International University, has set up a new interactive DSMOOC website that will undoubtedly become the focal point for diagnostic discussion and remediation. Check it out at http://discuss.thementalhealthmanual.com

Dr Nickel writes:

“Now that DSM-5 is about to be released, it is time to determine how best to reduce, if not entirely eliminate, the risk that people will be misdiagnosed and improperly treated.

“Solutions will not come from one group or one project. As one of what will hopefully be many initiatives, we have developed a MOOC (Massive Open Online Conversation) to bring together concerned clinicians and the public in order to give voice to the many different perspectives about psychiatric diagnosis.

“Our intention is to stimulate conversations that will lead to useful products. People will find each other and work together to produce materials that can empower patients and influence practitioners. Suggestions for guidelines, practice standards, public policy, and research will hopefully emerge. Certainly, we will make every effort to facilitate this.

“Previous MOOCs have resembled traditional university courses with lectures and quizzes on technical topics like artificial intelligence or mechanical engineering. Until now, MOOCs have not been closely linked to events happening in the world, nor have they been a channel for real world action. In this regard, a MOOC focused on DSM-5 may be pioneering.

“Our MOOC will consist of about 15 channels, each one dedicated to one area of significant change or controversy in DSM-5. Each will provide background information; videotaped discussions by leading experts and consumer advocates; references; links; vivid portrayals of psychiatric diagnosis in films and fiction; and an opportunity for discussion. There are even Google Hangouts all set up for study groups to use.

“Our DSMOOC should be equally interesting for professionals and consumers-and will provide a uniquely open forum for interaction between them.

“We hope that you will roll up your virtual sleeves, join us at: http://discuss.thementalhealthmanual.com.”

Thanks, Dr Nickel, for generating this terrific idea and for all the work and attention to detail that must have gone into setting it up. I have no doubt you will provide an enormously useful educational center and a much appreciated meeting place of ideas.

I can see only one possible consolation from the otherwise depressing DSM-5 debacle-perhaps it will stimulate a vigorous discussion of the real strengths but also serious weaknesses, of psychiatric diagnosis and treatment. The more that clinicians and patients know about psychiatric diagnosis, the greater will be its benefits, the fewer its harms.