Classification

Poring over Persons’ appeal for turning most experimental paradigms on their heads, and Widiger and Clark’s extensive critique of the current DSM (which Widiger himself had a hand in composing), it is easy to become disillusioned with the many formidable shortcomings in the field we’ve all just committed to. An unassuming parenthetical in Widiger and Clark gave me hope, however: “(American Psychiatric Association, 1952).” The DSM is only 57 years old! That’s younger than my parents! Of course mustering the audacity to codify the infinite range of human psychological experience took civilization this long. And of course in only IV iterations, we haven’t gotten it right yet.

I’m not letting psychology off the hook here. With so many great minds working in the field today (e.g., Jam Jr!!!), and with technological advances refining methods and measurements daily, the onus is as formidable as ever to be better at what we do. Widiger and Clark give us good starting points for doing so. The first DSMs were composed by what seems to have been an arbitrarily appointed minority via an undocumented, inaccessible process. W and C oppose an entirely “democratic” process because a consensus opinion may still not be a valid one. I understand the urge to protect psychology from politics, but how many times have the politics that were in play emerged only in retrospect? Psychology does not and cannot exist in a vacuum. I oppose appointing a small group of DSM authors with some monopoly on validity. If psychologists can’t agree with some reasonable degree of consensus on scientific validity by the time they’re ready to contribute to the DSM, I think this is more a problem with training than with bias.

The Laboratory Findings section of W and C underestimate the potential of lab methods for increasing the precision of diagnoses when they say, “laboratory assessment instruments are useful in exploring and perhaps documenting neuropsychological correlates but not necessarily in validating a neuropsychological model for their etiology or perhaps even their pathology” (Citations elided, but let me know if you want them). Here I looked at the publication date of this article: 2000. I think this description of lab limitations is dated. DSM-V will be forced to reckon with reams of neuropsychological correlate research, and I hope—not naively, right?—that by DSM-VI EEG and imaging will have become valid, economical and precise ways of diagnosing.

W and C’s sections “Boundary with Normality,” and “Differentiation among Disorders,” are very much in dialogue with Persons, who totally succeeded in convincing me to design research targeting psychological phenomena and not diagnoses. (Thank you so much Amori Mikami and Lab for collecting a community sample for the school study!) I hope that Persons has published or is working on a parallel paper on discussing psychological phenomena versus psychiatric diagnoses in clinical practice.

When I taught teenagers with ADHD and learning disabilities, I struggled to have helpful conversations with my students about their diagnoses. There was a movement at my school to familiarize students with the names and symptoms associated with their diagnosis, and it had many good intentions: externalizing the shame that comes with being different and being at a “special school” for kids with learning disabilities; engaging the body of intervention research associated with a specific diagnosis; and a general ethic of being open and honest with students to model being open and honest with self. These are all merited in their own way and certainly well intentioned, but I found that asking a 15-year-old to talk with their teacher about his existential feelings associated with having ADHD was more than either of us handle. ADHD, even to somebody who experiences it everyday, is still an abstraction, a dozen pages in the DSM, that is very hard to link to the chaotic state of your backpack, or the forgotten commitments, or lost iPod. How can that conversation not be reductive, overwhelming, depersonalizing? More than anything, though, it just felt so impractical, like it was taking time from devising and practicing strategies for organizing your backpack, reminding yourself of commitments, and hanging on to your iPod.

Also, getting diagnosed with anything still seems like the privilege of a minority lucky enough to have access to affordable mental heath care. Research that emphasizes symptoms and real problems people have (with or without psychopathology: see continuum discussions in both articles) will find a larger and more receptive audience. Dissemination of research is beyond the scope of this entry, but Persons, Widiger, and Clark all offer a beginner psychologist great tips for thinking about and doing research that expands our field’s sphere of influence with relevance, integrity and purpose.