Adam Blatner

Several months ago I sent this to the American Psychiatric Association’s committee in charge of making a new Diagnostic & Statistical Manual (DSM-5). I wrote: Though I’m retired from active practice in psychiatry now, I get questions from neighbors;  and also I teach and consult with various mental health professionals in training. My impression is that the most commonly-used diagnostic categories are anxiety disorders and depressive disorders. I’m concerned that these terms have come to imply primarily neurobiological conditions, which they occasionally are. But most often they are situations in life that would make otherwise fairly resilient people experience those symptoms. So one emphasis I want to see is on the need for assessment of the patient’s life situation and their strengths, as well as other variables. At present there seems to be little economic incentive for psychiatrists and other therapists to take the time to such assessments. Patients often cannot or should not be prematurely diagnosed and then out comes the prescription pad! Part of the process is not only for the treatment team, but also for the patient, help in getting a meaningful understanding of the stresses in their lives. My second point is that I think most therapists use diagnoses to get paid by insurance companies, and this is by far the major use of the DSM. I think this should be acknowledged. I appreciate that you’re trying to do a difficult task, perhaps impossible for the more in-between situations and people whose temperament and experience may elude what is considered "real" by those who are more materialistic.