This is the first major revision of the DSM in nearly 20 years. No one has seen it.
Not the complete, final, tangible version, at least. Interested psychiatrists have seen most of it, during the manual’s multiple open comment periods. For months — years — onlookers have dissected it with sharpened scalpels: Which diagnoses have been removed (Asperger syndrome). Which diagnoses have been added or reconfigured (hoarding). Whether the ones included are too broad, or too tied to the pharmaceutical industry, or maybe just too numerous.
Even before one can buy the DSM-5, one can buy books lambasting the DSM-5. Books with titles like “The Book of Woe.” Or “The Intelligent Clinician’s Guide to the DSM-5.” Or “Saving Normal,” which was written by an unexpected figure: the man who was the chair of the DSM-IV task force, the DSM-5’s predecessor, back in the 1990s.
There is a reason for the intense focus: Over the course of its 60-year history, the DSM has come to represent a diagnosis encyclopedia, a mental bible. It is made specifically for the psychiatric community, but an armchair hypochondriac may purchase it on Amazon.com for $135. (Hypochondriasis: a term that will not appear as usual in the DSM-5. Instead it will be combined with other disorders under the umbrella term “complex somatic symptom disorder.”)
It is the dictionary of our pain.
When we look at the DSM-5, what we’re looking at is 60 years of humanity’s attempt to understand what we will never give up trying to understand: ourselves. The last frontier of exploration in this vast, ever-expanding universe all takes place between our ears, and it’s all corralled into the pages of this manual.
A long road to revision
The American Psychiatric Association is headquartered in Arlington, on the 20th floor of a high-rise three blocks from the Rosslyn Metro. Most of the APA’s interior is bland — cubicles measured off like inches on a ruler — but the window offices have sprawling views of the Potomac River.
One such window office belongs to James Scully, the chief executive officer and medical director of the APA. This afternoon, a baking April weekday, he sits in it with Darrel Regier, the co-chair of the task force charged with the DSM-5 revision (the chair, who is not here today, is David Kupfer).
Scully has white hair and blue eyes and a soft voice that occasionally twinkles; you can picture him somewhere on a canoe or in front of a fireplace. Regier is dark-haired, thorough — a man who gives precise, date-packed answers, swaddled in history and context.