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本帖最后由 misir 于 2010-2-9 11:05 编辑
Psychiatric diagnosis
That way, madness lies
A new manual for diagnosing diseases of the psyche is about to be unveiled
Feb 4th 2010 | From The Economist print edition
Prepare to have your paradigms shifted ON FEBRUARY 10th the world of psychiatry will be asked, metaphorically, to lie on the couch and answer questions about the state it thinks it is in. For that is the day the American Psychiatric Association (APA) plans to release a draft of the fifth version of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Mental illness carrying the stigma that it does, and the brain being as little-understood as it is, revising the DSM is always a controversial undertaking. This time, however, some of the questions asked of the process are likely to be particularly probing.第一段把大致的情况讲了下,2月10日APA将要把第五版DXM-V草案公之于众。
The DSM, the first version of which was published in 1952, lists recognised psychological disorders and the symptoms used to diagnose them. In the United States, what is in it influences whether someone will be diagnosed with an illness at all, how he will be treated if he is so diagnosed, and whether his insurance company will pay for that treatment. Researchers in other countries generally defer to the DSM, too, making the manual’s definitions a [url=]lingua franca[/url][s1]
for the science of medical psychology. And, perhaps most profoundly, the DSM influences how mental illness is understood by society at large. 自第一版DSM出版以来,它的适用性越来越强。
A new DSM, then, is an important document. The APA has been working on the latest revision since 1999, and will not release the final version until May 2013. But some people are already accusing it of excessive secrecy and being too ambitious about the changes it proposes. Those critics will be picking over the draft next week to see if their fears have been realised.
Manual dexterity
The original DSM reflected the “psychodynamic” view of mental illness, in which problems were thought to result from an interplay between personality and life history. (Think Freud, Jung and long hours recounting your childhood and dreams.) The third version, which was published in 1980, took a more medical approach. Mental illnesses were seen as distinct and classifiable, like physical diseases. DSM-III came with checklists of symptoms that allowed straightforward, unambiguous diagnosis. Psychiatry began to seem less like an art form and more like a science. DSM从第一版到第三版的发展过程。。。从艺术走向科学
DSM-III also introduced many more diagnoses than had appeared before. These included [url=]attention-deficit disorder[/url][s2] , [url=]post-traumatic stress disorder[/url][s3] and social phobia. In fact, the number of specific diagnoses more than doubled between DSM-I and DSM-III, from 106 to 265. DSM-IV, published in 1994, increased the number to 297, but left the underlying model alone.
The APA’s DSM-V [url=]task force[/url][s4] , however, has suggested it would like to introduce a “new paradigm” into the manual. It wants to recognise that many conditions, such as anxiety and depression, tend to overlap, so that a diagnosis of only one or the other does not always make sense. The new version of the DSM is also expected to include a “dimensional” component, one that considers the severity as well as the nature of symptoms. This could lead to the paradoxical situation of a symptom (minor depression, for example) being classified as being below the threshold for the diagnosis of a disease, but nevertheless still being regarded as a problem—leaving the individual so diagnosed in a weird medical limbo.最新的DSM希望能包含病症和严重程度。
【The chairmen of two previous DSM task forces have been particularly critical of the present effort. In a letter to Psychiatric Times, written last June, for example, Allen Frances, a psychiatrist at Duke University who chaired the DSM-IV task force, accused his successors of being too secretive, and of closing themselves off from outside opinion. He also worried that adding dimensional ratings to the DSM could lead to many more diagnoses based on symptoms that would previously have placed an individual in the normal range. Pharmaceutical companies, eager to expand their markets, would be tempted to pounce on these new “patients”. Dr Frances was supported by Robert Spitzer, a professor of psychiatry at Columbia University who was chairman of the DSM-III task force.
Members of the present task force, led by Alan Schatzberg, president of the APA, fired back a letter pointing out that they have held conferences, presented papers and consulted more than 200 outside advisers. They also accused Dr Frances and Dr Spitzer of having a financial interest in books based on the DSM-IV criteria. The two admit to receiving royalties, but say it has nothing to do with their criticism.】可以作为scandal 的实例
In the meantime, particular groups who may or may not be classified as “diseased” are also concerned about what ends up in the manual. Some of those with[url=] Asperger’s syndrome[/url][s5] —who find it hard to “read” the emotional states and intentions of others, but have otherwise typical intellectual faculties—are worried by hints that their condition might be included under the more general heading of “[url=]autism[/url][s6] spectrum disorder”. That would [url=]lump[/url][s7] them with people whose intelligence is profoundly impaired. Transsexuals, meanwhile, want the diagnoses of “gender identity disorder” and “transvestic fetishism” that the new DSM is expected to promulgate changed to be more respectful and less judgmental. In fact, any changes to the list of sexual disorders, including a possible new category called “hypersexual disorder”, are bound to get attention.有很多专业术语。。。
February 10th will be the first chance most people, including the critics, have to look at the document. When they do, the criticism is likely to get louder. After all, the effort to classify and categorise disorders of something as complex as the human mind—especially when that categorisation is done by committee—is unlikely to please everybody. It will be interesting to see what direction the new DSM is going in, and whether it stands up to analysis.
[s1]something resembling a common language <movies are the lingua franca of the twentieth century ― Gore Vidal>
[s2]a syndrome of disordered learning and disruptive behavior that is not caused by any serious underlying physical or mental disorder and that has several subtypes characterized primarily by symptoms of inattentiveness or primarily by symptoms of hyperactivity and impulsive behavior (as speaking out of turn) or by the significant expression of all three ― abbreviation ADD
[s3]a psychological reaction occurring after experiencing a highly stressing event (as wartime combat, physical violence, or a natural disaster) that is usually characterized by depression, anxiety, flashbacks, recurrent nightmares, and avoidance of reminders of the event ― abbreviation PTSD ― called also post-traumatic stress syndrome
[s4]a temporary grouping under one leader for the purpose of accomplishing a definite objective
[s5]a developmental disorder resembling autism that is characterized by impaired social interaction, by restricted and repetitive behaviors and activities, and by normal language and cognitive development ― called also Asperger's disorder
[s6]a variable developmental disorder that appears by age three and is characterized by impairment of the ability to form normal social relationships, by impairment of the ability to communicate with others, and by stereotyped behavior patterns自闭症
[s7]verb [VN] ~ A and B together
~ A (in) with B to put or consider different things together in the same group: You can't lump all Asian languages together. |
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