Saturday, September 21, 2013

mental disorders made accessible

review of

Essentials of psychiatric diagnosis: Responding to the challenge of DSM-5

by Allen Frances

The Guilford Press, New York, June 2013

In April this year, I wrote a feature about the criticism levelled at the new edition of the Diagnostic and Statistical Manual of mental disorders, DSM-5, which appeared in May. One of the critics I cited was Allen Frances, MD, who had criticised from the preparatory stages of the new edition that it was making diagnostic criteria too wide and too vague, at the risk of making mental patients of us all.

Frances is not only a distinguished psychiatrist (he chaired the team that prepared the fourth edition and was also involved with the third edition of the DSM) but also a prolific writer, so he prepared his own, anti-DSM-5 diagnostic guide in time to be published almost simultaneously with the big manual. As he told his publishers about my article, they kindly sent me a review copy of the book.

I was a bit apprehensive at first, as the title sounds somewhat technical and forbidding, but sampling some of the chapters I soon found out that it is highly readable for lay readers. Each chapter for a specific mental disorder has very clear signposting including a screening question, description of a prototype case, and differential criteria to distinguish the condition from separate, but similar ones, or, indeed, from the fringes of normal behaviour. The last distinction is possibly the most important one, as the risk that all variability in human behaviour may get labelled pigeon-holed into psychiatric categories and treated with drugs provided by an all too eager pharmaceutical industry is a growing concern.

The book is “meant for everybody with an interest in psychiatric diagnosis” – not just medical professionals and students, but also anybody who cares about a person who may have mental health problems. Recognising problems early can save lives. And as some of these disorders seem to be spreading, the target audience may well include most of us.

PS: A revised edition has just come out on September 18th. According to the blurb on Amazon, it “features ICD-10-CM codes where feasible throughout the chapters, plus a Crosswalk to ICD-10-CM Codes in the Appendix. The Appendix, links to further coding resources, and periodic updates can also be accessed online (”

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