Is DSM a "work of fiction" ?

Psychiatrists are working on the fifth edition of a manual that is both medical guidebook and cultural institution. Diagnostic and Statistical Manual of Mental Disorders (DSM). A release of the final, approved DSM-V is expected in May 2012.

But there is scientific and political controversy regarding the continued inclusion of sex-related diagnoses such as the paraphilias (sexual fetishes) as it was when they finally decided in 1974 to remove homosexuality as a category of disorder and replaced with the diagnosis of ego-dystonic homosexuality in the DSM-III in 1980 to finally remove it in 1987 with the release of the DSM-III-R and adding a category of “sexual disorder not otherwise specified” in the DSM-IV-TR, which may include “persistent and marked distress about one’s sexual orientation.”

Furthermore some pyschiatrist claim that the removal of the Paraphilias (sexual fetishes) from the DSM is not going to happen because it would be a public relations disaster for psychiatry.

In the 80s and 90s it was possible for interested professionals to witness the transition of the DSM-III to the III-R and the IV, including all the compromises with various interest groups that added, deleted, or re-defined various categories (so much for scientific “diseases”). It is no more possible now. Discussions will be kept secret. It does not help for people who are highly suspecious of Psychiatry.

There is no other branch of medicine where “symptoms” and “diagnoses” are so clearly invented, and where you can still diagnose a disorder even if it lacks the necessary criteria.

Of course DSM is an empirical document and the relative success of physics should not blind us to the fact that causal explanations are not the only interesting thing in science. Empirical means descriptive, based on observation.

The virtue of DSM in all its revisions is that it brings together and summarizes, as precisely as anyone is able to do, what thousands of pyschiatrists have seen in day-to-day dealings with real patients.

But based on current research, there seems to be a lack of consensus regarding the descriptions of mental disorders. For example, compelling studies suggest that some mental disorders (e.g., schizophrenia, bipolar disorder) are linked to brain abnormalities and genetic factors. It is premature, however, to conclude that these connections are absolutely true.

People who see the need of these descriptions remind us “about schizophreniais a serious brain illnesses that we cannot say it does not exist.” Let say that schizophreniais is a reality but nobody has proved that it is somatic (physical illness): “the independent evidence for somatic causes as the only, or even the main non-hereditary factor in schizophrenia is not sufficient … Schizophrenia is probably a partly sociogenic brain disorder produced by impoverished social environments”.

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