Download a PDF of the 2012 Annual Report - Black Dog Institute

The BlackDog InstituteInternationalLecturesThe Uses and Misuses of Psychiatric Diagnosis – Professor Allen Frances MDProfessor Allen Frances, prior Chair of theDSM-IV Task Force and Professor Emeritus, DukeUniversity, cogently presented his views on the problemsof the latest update of the DSM (Diagnostic andStatistical Manual of Mental Disorders), DSM 5, andthe very real concerns evidenced by fellow professionalsand members of the public. His lecture, delivered inthe Institute’s Robert Dean lecture theatre on June 20,was filled to overflowing.Dr Frances first traced the antecedents ofpsychiatry to more modern times and through tothe DSM. From interpreting which spiritual entity wasangry and what was needed to appease it, managementof disturbed people moved from more aggressiveinterventions to focus on what was wrong with theindividual and how best to treat the illness.Early to mid 20 th Century saw a growing needto collect uniform statistics about mental disorder andfor clinicians to be able to ‘read off the same page’.This led to the development in America of a psychiatric‘manual’ for categorising mental disorders, theDSM-I. In Europe, the International Classification ofDiseases (ICD) also had a section on mental disorders.However, by the 1980s this psychiatric classificationsystem was becoming irrelevant. Inter-raterreliability for each diagnostic category was very low.The DSM task force partially addressed this, and alsodeveloped semi-structured interviews. But the definitionsin the DSM are still theoretical and open to multipleinterpretations.Particularly concerning in the DSM 5 are the‘subsyndromal’ disorders; confusion about whether tofocus on symptoms or on behaviour; the misuse ofthe Manual (for example, its diagnoses are ‘built into’judgments for US healthcare insurance); and judgmentsin the forensic area. Unprecedented numbersof adults and children are being treated for increasingnumbers of possible psychiatric disorders, and thereare real concerns about the accuracy of the data in theDSM 5 itself.BLACK DOG 201257