I read your blog with pleasure, but don't comment because, well, I have too many passwords to remember already. But I would like to comment on your view about DSM and mental illness.
I don't think DSM is perfect, it's not always even very good. It does help us think clearly and non-etiologically about what we see in our patients. If we don't know etiology (and Lord knows, we don't), then phenomenology is not a bad way to go. Some assurance that when I say my patient has major depression that my colleagues in California, Pennsylvania, Chicago, Wyoming, and even Toronto will agree, means that we can talk about what works and what doesn't. That we can say, "this group of patients are enough alike in how they think, say they feel, behave, and the course of what's going on if we don't treat it", that we can look for commonalities in the biology and physiology and all and keep looking for etiology. Well, we can look for the biological what, we are never any good at why. Neither is any other field of medicine. We like to think we leave that to the church and the philosophers, but they are different mostly in being willing to tackle it.
As to illness being defined by interference with function: that's an idea very basic to medicine. A broken bone interferes with the normal function of bone, so it's "pathology", fancy word for illness. Measles or even a bad viral upper respiratory illness (=head cold) interferes with the function of a school child in learning and playing well with others at school--and so they are illnesses. Major depression means you can't concentrate, can't think, can't decide which shoe to put on first, and see no chance of change. It's not the sin of despair, at least, not if you go seek help. And those are things that an observer can see: you can't function in your usual roles. That's a striking one, but even the more subtle ones we don't depend solely on the say-so of the sufferer. We observe, we ask questions, we see whether the whole pattern fits one of the paradigms of "this is a cluster of signs [what's objectively observed] and symptoms [what the patient complains of] which occur together often enough that we recognize the pattern, have called it X, and here's our best stab at alleviating it".
Which is not always with medication.
On the other hand, no quarrel that we've gotten far too dependent on Pharma (the medical equivalent of the military-industrial complex) for too long. We can't do our job without (some of) their products, but we need to take control back.
So please reconsider the question of the use of diagnostic manuals, of the definition of illness.
And keep up the blog, which I enjoy. I have one (down at the moment, but will reappear when my daughter fixes it: Called Judithio,
http://www.newrambler.net/judithio
Mostly but not entirely my journaling aloud about street ministry and discernment towards diaconate. I was confirmed in 1969 in Toronto--a grad student at UofT then, attending Grace Church on the Hill; we were confirmed at a small inner-city parish (I don't remember where now) where the Bishop was when we were in town (it gets complicated). Anyway, clearly being an Episcopalian has stuck. Thank you for your work in Toronto.
Cordially, faithfully, wishing you joyous Advent and Christmas,
Judith Crossett
Judith H. W. Crossett, MD
Director, Geriatric Psychiatry
Clinical Professor of Psychiatry
University of Iowa Carver College of Medicine
I'll just add that I do have a copy of the DSM-IV TR on my office book shelf alongside some other reference books that I occasionally use to look up one thing or other. So I'm not actually as anti-DSM as my previous post might have suggested, I guess I go back and forth on these issues. So a big thanks to Judith for calling me to explain myself better.
-t
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