DSM-5′s Validity: Non Sumus Angeli!

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Whenever some reporter makes the fatuous claim, “The DSM is psychiatry’s bible!” I am reminded of a story concerning the Vatican, during the years of Pope John XXIII. It seems that a new building had to be constructed on Vatican grounds, and the architect submitted his plans directly to the Pope. Soon the plans were returned to the architect with the words “Non sumus angeli” written in the margin: “We are not angels.” The architect and his staff were baffled as to what the Pope meant, until finally someone noticed the plans did not include bathrooms.

No, psychiatrists are not gods or angels, and the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)[1] is not our “bible.” It is a useful but incomplete text; an informative but fallible guide. Many of us respect the time and effort that went into developing the DSM-5, while also hoping that DSM-5.1 or -5.2 will provide substantially more. Of course, we would all like more neuroscience, and many of us would like to see more psychodynamic explication of the major disorders. Although symptom checklists lend themselves to the goals of research — for example, establishing cut-offs and inclusion criteria for a particular study — they rarely answer the needs of clinicians for a comprehensive understanding of the patient.[2] I believe that the framers of the DSMs have always acknowledged this limitation.

That said, I bristle when I hear some in the mental health field — and many in the mass media — argue that the DSM- 5 is “not valid” because it lacks definitive biological tests or biomarkers. This sort of claim reflects a profound misunderstanding on the part of both the general public and, alas, many clinicians: namely, the identification of “scientific” with “laboratory test” or “radiologic image.” This amounts to a kind of scientism, not science, and the public has been sold a bill of goods on this subject.

by Ronald W. Pies, M.D., Medscape

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