Passage 3 Psychiatry’s Civil War
DSM修订备受争议 《新科学家》

 

[00:00]When doctors disagree with each other,
[00:04]they usually expressed their criticisms in careful, measured language.
[00:11]In the past few months, however, open conflict has broken out
[00:17]among the upper echelons of US psychiatry.
[00:22]The focus of disagreement is a volume called
[00:26]the Diagnostic and Statistical Manual of Mental Disorders, or DSM,
[00:34]which psychiatrists turn to when diagnosing the distressed individuals
[00:40]who turn up at their offices seeking help. Regularly referred to
[00:46]as the profession's bible, the DSM is in the midst of a major rewrite,
[00:53]and feelings are running high.
[00:56]Two eminent retired psychiatrists are warning that the revision process
[01:02]is fatally imperfect. They say the new manual, to be known as DSM-V,
[01:11]will extend definitions of mental illness so broadly that tens of millions
[01:18]of people will be given unnecessary and risky drugs.
[01:23]Leaders of the American Psychiatric Association (APA)have shot back,
[01:31]accusing the pair of being motivated by their own financial interests
[01:38]a charge they deny. The row is set to come to a head next month
[01:45]when the proposed changes will be published online.
[01:50]Psychiatry suffers in comparison with other areas of medicine,
[01:56]as diseases of the mind are on the whole less well understood
[02:01]than those of the body. We have, as yet,
[02:06]only glimpses into the fundamental causes of the common mental illnesses,
[02:13]and there are no biological tests to diagnose them.
[02:18]This means conditions such as depression, schizophrenia
[02:23]and personality disorders remain difficult to diagnose with precision.
[02:30]Doctors can only question people about their state of mind
[02:35]and observe their behaviour, classifying illness
[02:39]according to the most obvious symptoms.
[02:43]The difficulty of separating mental disorders from normal variation in
[02:49]behaviour made it controversial from the start. Over the years,
[02:55]the book's influence has grown,
[02:58]and today it is used by doctors across the globe.
[03:02]The wording used in the DSM has a significance
[03:07]that goes far beyond questions of semantics.
[03:11]The diagnoses it enshrines affect what treatments people receive,
[03:18]and whether health insurers will fund them.
[03:22]They can also worsen social stigmas
[03:25]and may even be used to deem an individual such a grave danger to society
[03:32]that they must be locked up.
[03:35]Some of the bitterest arguments stem from worries
[03:39]about the pharmaceutical industry's influence over psychiatry.
[03:44]This has led to the spotlight being turned on the financial ties of
[03:49]those in charge of revising the volume, and has made any diagnostic changes
[03:56]that could expand the use of drugs especially controversial.
[04:02]Few would claim that the DSM's current version is perfect.
[04:07]With each revision, the number of conditions it defines has expanded,
[04:13]many surrounded by confused lists of symptoms
[04:18]that must be checked to assign a diagnosis.
[04:22]At the same time, many patients prove hard to fit into the framework.