The DSM has to prioritize reliability when defining mental disorders to prevent disagreement, which sacrifices validity
Reliability and validity must be balanced when defining mental disorders. Ideally, of course, the definition of a disorder would do both—be both reliable and valid. But to meet the goal of reliability, the defining symptoms must be extremely simple, obvious, and generalize easily across all the people with that particular disorder. If the criteria set includes items that are inferential or complicated, different clinicians will disagree on whether or not they are present.
The DSM takes a left hemisphere approach. The right hemisphere allows for the recognition of uniqueness and familiarity, while the left only re-presents generic categories of things. Worshiping at the temple of reliability, the DSM criteria sets are as simple as they can be—a catalog only of what is most surface and common in mental disorders. This was a necessary choice, but it necessarily compromises validity—constraining ourselves to the simple blinds us to subtlety, nuance, and individual variability. A great deal is lost in the translation between the rich diversity of different individual experiences of depression and the bland five-of-nine criteria set chosen to define it. In describing the characteristics shared by those who meet the criteria for a given mental disorder, the DSM definitions must obscure the ways they are individual and different. DSM definitions do not include personal and contextual factors, such as whether the depressive symptoms are an understandable response to a loss, a terrible life situation, psychological conflict, or personality factors. And The left hemisphere sees things abstracted, isolated, and stripped of context.
References
- Frances, Allen. (2013). Saving Normal CHAPTER 1. What’s Normal and What’s Not? (p. 46). New York, NY: HarperCollins.
Metadata
Type:🔴 Tags: Psychiatry Status:☀️