I feel like the core criticism here isn't necessarily of structure itself, but that the type of structure applied when creating the DSM-V is not necessarily a helpful structure. Grouping things into neat categories and assigning them a name is useful in the case where structure actually helps patients, but it's possible to harm them just as much if it goes beyond being a diagnostic tool and rule of thumb.
I don't think the DSM-V protects against the problem you observed when seeing a psych, either. I saw one a while back who did believe in the DSM-IV (V wasn't out at the time) and his approach was still 'it sounds like you fit the clinical definition of this; I can prescribe you this medication'. The diagnostic process was, ultimately, 'if this medication helps you probably have this condition'. I think it's reasonable for that to unnerve you, but that's really just a symptom of how difficult it is to actually draw concrete, verifiable conclusions about this stuff.
Many of the conditions described in a tome like the DSM-V as a singular condition end up having wildly varied symptoms and there end up being treatments that only work for one subset of people with the condition, while another treatment only works for another subset. Some people who have a condition only show a tiny subset of the symptoms. I think it's reasonable to look at that and ask if some well-meaning people have gone overboard in an attempt to label and categorize everything.
On a related note, there are many marginalized groups out there that feel victimized by the authors of tomes like the DSM, because it often classifies things as 'disorders' that ought not necessarily be a disorder. Those with unusual sexual orientations, gender identities, or social habits are among the people who at one time or another have been considered mentally deficient or mentally ill due to classification. I don't think the people authoring those classifications necessarily intended to harm those marginalized groups, but that often IS the result.
The problem is that psychiatrists aren't really interested in much other than prescribing medications. Therapy is left to those with degrees in clinical psychology or social work.
And from what I have experience with--the eating disorder community--many professionals actually discredit the DSM's categorization (though it has much improved in the DSM-5) because of its insistence on weight for diagnoses of anorexia nervosa. But great American insurance often will pay for nothing if the patient does not have either AN or BN leading to patients being "not sick enough" for treatment when really, they need it as soon as possible for recovery to be most successful.
i don't really disagree with you, but it seems to me that the problem is that there are good doctors and crappy doctors. DSM-V seems to be a side-issue; it's just a tool. arguing about it seems to be the psychiatric equivalent of criticising programming languages...
(i got a second opinion from someone who spent much more time talking with me, understanding what was happening, and discussing possibilities. he used DSM-V as a framework that allowed him to structure things. that was all. he was awesome and i was happy with his decision. and that's because he was a good doctor, not because of DSM-V. but as a good doctor, he wasn't discarding a useful tool for "religious reasons")
[edit: all the above is necessarily simplified; i now feel a bit guilty in portraying the first doctor so negatively. there's clearly factors like client-doctor "fit" involved, too.]
Comments
I feel like the core criticism here isn't necessarily of structure itself, but that the type of structure applied when creating the DSM-V is not necessarily a helpful structure. Grouping things into neat categories and assigning them a name is useful in the case where structure actually helps patients, but it's possible to harm them just as much if it goes beyond being a diagnostic tool and rule of thumb.
I don't think the DSM-V protects against the problem you observed when seeing a psych, either. I saw one a while back who did believe in the DSM-IV (V wasn't out at the time) and his approach was still 'it sounds like you fit the clinical definition of this; I can prescribe you this medication'. The diagnostic process was, ultimately, 'if this medication helps you probably have this condition'. I think it's reasonable for that to unnerve you, but that's really just a symptom of how difficult it is to actually draw concrete, verifiable conclusions about this stuff.
Many of the conditions described in a tome like the DSM-V as a singular condition end up having wildly varied symptoms and there end up being treatments that only work for one subset of people with the condition, while another treatment only works for another subset. Some people who have a condition only show a tiny subset of the symptoms. I think it's reasonable to look at that and ask if some well-meaning people have gone overboard in an attempt to label and categorize everything.
On a related note, there are many marginalized groups out there that feel victimized by the authors of tomes like the DSM, because it often classifies things as 'disorders' that ought not necessarily be a disorder. Those with unusual sexual orientations, gender identities, or social habits are among the people who at one time or another have been considered mentally deficient or mentally ill due to classification. I don't think the people authoring those classifications necessarily intended to harm those marginalized groups, but that often IS the result.
The problem is that psychiatrists aren't really interested in much other than prescribing medications. Therapy is left to those with degrees in clinical psychology or social work.
And from what I have experience with--the eating disorder community--many professionals actually discredit the DSM's categorization (though it has much improved in the DSM-5) because of its insistence on weight for diagnoses of anorexia nervosa. But great American insurance often will pay for nothing if the patient does not have either AN or BN leading to patients being "not sick enough" for treatment when really, they need it as soon as possible for recovery to be most successful.
It also seems like there's a rivalry between psychiatrists and the psychologists. I wonder if the latter have their own equivalent text to the DSM.
i don't really disagree with you, but it seems to me that the problem is that there are good doctors and crappy doctors. DSM-V seems to be a side-issue; it's just a tool. arguing about it seems to be the psychiatric equivalent of criticising programming languages...
(i got a second opinion from someone who spent much more time talking with me, understanding what was happening, and discussing possibilities. he used DSM-V as a framework that allowed him to structure things. that was all. he was awesome and i was happy with his decision. and that's because he was a good doctor, not because of DSM-V. but as a good doctor, he wasn't discarding a useful tool for "religious reasons")
[edit: all the above is necessarily simplified; i now feel a bit guilty in portraying the first doctor so negatively. there's clearly factors like client-doctor "fit" involved, too.]