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The title is the second line of the Tao Te Ching.  To make sense of the world, we attach names to everything, and sometimes think the name and the thing are the same thing. But a word is just a sound we agree on as a representation of something, and no two of us experience that something exactly the same way. My notion of the color blue or experience of an apple is different than yours.

In behavioral health, diagnosis is a driving force. Some folks find putting a name to a behavior helps very much. For others, it does not help and may even hinder change, particularly when that name says that one is diseased and will never get better.  At times, the person becomes the name. The medical model in the past has functioned that way, and in an ironic way has actually increased stigma while seeking to lessen it. (see Models of Madness, edited by Read, Mosher, and Bentall)

In about ten days, the DSM 5 will be released.  NIMH has decided not to use it. There has been ongoing controversy about how it was put together.  Salon has a pretty good article about this at http://www.salon.com/2013/05/05/the_book_of_woe_psychiatrys_last_stand/.

When it comes to diagnosis in behavioral health, the United States goes its own way, just as it has done with measurements.  The rest of the world is metric, while we stick to the old standard system.  The rest of the world uses the ICD 10, while we are using the DSM IV TR for now. The US is scheduled to change over to the ICD 10 in a couple of years. Unless of course it is postponed again. We will see. After all, we were supposed to convert to the metric system decades ago.  For a short time, even highway signs displayed both miles and kilometers. No more.

This afternoon I got to participate in my first field trial for the World Health Organization in its beta work on the ICD 11.  I was given a list of diagnoses with the diagnostic criteria for each one – diagnoses covering areas such as PTSD, grief, stress reactions – and then given two case studies to diagnosis. I was then asked about my diagnosis and the criteria I used, severity of symptoms, and how confident I was of the diagnosis.  I found the criteria to be more descriptive and straight forward than the DSM. I have been using the DSM since the original version III and have never particularly been comfortable with it in terms of its practical use, other than you have to diagnosis in order to bill. And you need to be extremely careful of what diagnostic label you give to someone because it will most likely follow them for the rest of their lives with various consequences along the way. I wish that were emphasized in graduate schools and treatment programs more. Give the least pathological diagnosis possible.

The feel I got from the initial study was that the at least in what I read, there is less of a pathology orientation and more of a descriptive approach. I hope that stays the case. I am looking forward to the next trial.

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