Thursday, June 3, 2010

DSM-5 Controversy and the Internet

Hanna Decker, a historian of psychiatry, recently wrote a very informative and ballanced account of the controvercy surrounding DSM-5, especially with criticsms repetedly made by Robert Spitzer (chair of the DSM-III Task Force) and Allen Frances (chair of the DSM-IV Task Force): A MOMENT OF CRISIS IN THE HISTORY OF AMERICAN PSYCHIATRY

In her observations at the end of her history, she makes a remark that I certainly found relevant to my blogging efforts:
The role of the Internet in popularizing and spreading the arguments and charges made by Robert Spitzer and Allen Frances cannot be overstated. Without the Internet, the ease and rapidity of their frequent attacks and challenges would have been impossible. It is worth repeating the trite observation that the Internet is the printing press of the 21st century, well adapted to fomenting upheavals.

Allen Frances, has written a rather interesting response in which he reflects on this point.
This leads to an interesting, if unanswerable, corrolary question. Has the internet debate on balance helped or hurt DSM5- or has it had no meaningful effect at all? It is, of course, too early to tell how this very small piece of history will play out. The attention drawn to the DSM5 process has led to some improvements in its methods and a more realistic timetable. But on the larger substantive issues, it is my view that DSM5, despite all the debate, remains stubbornly lost in the wilderness.

Later, he furthers his query about the role of the internet, and his decision to make his criticsms in a public forum, aiming for external pressure, rather than trying to privately influence decisions:
But the long term pluses and minuses of internet vs private influence remain unclear. The internet certainly played a large role in stimulating debate-but the resulting debate has not so far accomplished anything of lasting value. It is an open question whether things might have gone better if there were no public debate and I instead quietly proffered advice to the DSM5 leadership, the Work Group members, and the APA Trustees? In all likelihood, the private approach would not have had any influence whatever (I think all were pretty resistant and, on the down side, DSM 5 might then have gone ahead with the premature field trial). But we will never know.

It certianly gives a blogger room for reflection.

And then, as a good blogger, I left a comment:

While reading Professor Decker's history, I had this considerable urge to go blog about it and your article (which I had not yet read.) After finishing that history, and while reading your article, I couldn't help but note the irony of this impulse. So, being a good blogger, I decided to leave a comment about it.

And now I think I'll go do my blogging :-)

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