The DSM-5: A Psychopathological Analysis

Psychopathology is the scientific study of mental disorders: a topic that most, if not all of the population has had to deal with on a personal level, whether they themselves are personally affected by it or a friend/family member is. Despite this connection, all forms of psychopathology—from mild depression to severe schizophrenia—have had a complex, if not contradictory relationship in establishing itself as a science. The recent publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has attempted to do just that, creating a system that allegedly classifies and diagnoses mental disorders in an accurate, scientific way. However, due to the fluidity of mental illness diagnosis, the DSM-5 does not and
cannot fulfill the nickname of being the psychiatric “bible.” One of the major promises of the DSM-5 is that, along with signs and symptoms, it would include information about “various biomarkers of the major disorders…with reasonable measures of sensitivity and specificity” (Nemeroff). However, Charles B. Nemeroff and Daniel Weinberger argue that, while these disorders are very much genetically influenced and, thus, make it plausible for specific genetic markers to be found, it greatly simplifies these complex disorders and has not been recognized in psychiatry and a majority of other medical branches. Furthermore, a series of brain scan images that improved understanding of the neurobiology of psychiatric disorders could not be used in the DSM-5 as they had no “pathognomonic findings that could be incorporated.” Nemeroff and Weinberger stated that “…none of this is surprising, as the complexity of brain development and of the central nervous system, with its 100 billion neurons that make 500 to 800 billion connections, involves thousands of unique cell types…” Similarly, with mental illnesses such as depression, there is a combination of gene-environment interaction that makes each case individualistic (Stanford Medicine). The DSM-5 does not take such effect into account, thereby furthering it from being the “standard reference for clinical practice in the mental health field.” Previous versions of the DSM were criticized for being overly subjective and vague due to the methods of diagnosis relying heavily upon assumptions about personality styles and psychological concepts.
The introduction of the DSM-III established a much more grounded basis for diagnosis, but Nemeroff and Weinberger fear that the DSM-5’s “classification [of mental disorders] using biological phenomena…which are highly dependent on context and research protocol may reintroduce some of this earlier vagueness, subjectivity, and imprecision.” Both also fear that the inclusion of biological classification will lead to an overall misdiagnosis. Allen Frances has a similar worry, believing the DMS-5 relies more so on diagnosis fads than a patient’s true psychiatric state that are “likely to be over-diagnosed, lead to unnecessary stigma, overtreatment, a misallocation of resources and impact on the way people see themselves.” Another problem with the DSM-5 its lack of This gray area does not cause difficulty with diagnosis, but it causes difficulty in the classification of what can be diagnosed. Furthermore, an affected individual may not fully understand their symptoms, thus limiting the chances for a proper diagnosis. Yet again, this challenges the idea of who is an expert as the traditional expert may have to rely solely on
inferences. One of the other major reasons for this expanse of gray area is due to psychiatry being unable to be measured as done in hard sciences—such as biology, physics, and chemistry—where experiments can be repeated with the same results.
Psychiatry relies more on the “soft” aspects of science: ones that cannot be so easily measured. In doing so, there is much room for interpretation. As Alex Berezow explained, “Psychologists can't use a ruler or a microscope, so they invent an arbitrary scale. Today, personally, I'm feeling about a 3.7 out of 5. How about you?” While Berezow’s use of “arbitrary” can be offensive to those within the psychological and psychopathological fields, the case still stands: there is no absolute measure for psychology. This limitation paves the way for difference in opinion. As Berezow explain, he may feel like a 3.7, but a psychological screening may put him at a 2 or 4, depending on how he answers questions. This conflict between patient and psychologist once more raises the question of if the patient is the true expert of their own mind. However, if the patient cannot fully understand their symptoms and therefore does not report them, it
would Once more, this does nothing to invalidate psychopathology, psychology, or individuals affected by it. Those trained within psychopathology understand the human mind and its faults much more than others, but that only applies to the, for lack of a better word, average human mind. Individuals affected with psychopathology go to psychopathologists due to their well-deserved trust. As explained by Carl Beuke of Psychology Today, expertise cannot be gained through merely learning, but rather, through a combination of continued exposure, practice, and general understanding, and this especially goes for experts in psychopathology. While they may never become true experts due to the subjectivity of the human mind and condition, being around unique cases will allow for psychopathologists to gain a better understanding of their fields and, as a result, allow them to better help those affected by forms of psychopathology.