Phillips James, Frances Allen, Cerullo Michael A, Chardavoyne John, Decker Hannah S, First Michael B, Ghaemi Nassir, Greenberg Gary, Hinderliter Andrew C, Kinghorn Warren A, LoBello Steven G, Martin Elliott B, Mishara Aaron L, Paris Joel, Pierre Joseph M, Pies Ronald W, Pincus Harold A, Porter Douglas, Pouncey Claire, Schwartz Michael A, Szasz Thomas, Wakefield Jerome C, Waterman G Scott, Whooley Owen, Zachar Peter
Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA.
Philos Ethics Humanit Med. 2012 Jan 13;7:3. doi: 10.1186/1747-5341-7-3.
In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part I of this article will take up the first two questions. With the first question, invited commentators express a range of opinion regarding the nature of psychiatric disorders, loosely divided into a realist position that the diagnostic categories represent real diseases that we can accurately name and know with our perceptual abilities, a middle, nominalist position that psychiatric disorders do exist in the real world but that our diagnostic categories are constructs that may or may not accurately represent the disorders out there, and finally a purely constructivist position that the diagnostic categories are simply constructs with no evidence of psychiatric disorders in the real world. The second question again offers a range of opinion as to how we should define a mental or psychiatric disorder, including the possibility that we should not try to formulate a definition. The general introduction, as well as the introductions and conclusions for the specific questions, are written by James Phillips, and the responses to commentaries are written by Allen Frances.
面对围绕《精神疾病诊断与统计手册》（DSM）编制过程的诸多争议，尤其是《精神疾病诊断与统计手册》第五版（DSM - 5）的编制争议，我们组织了一场讨论，围绕我们认为在DSM后续工作中的六个关键问题展开。这六个问题包括：1）精神障碍的本质；2）精神障碍的定义；3）在当前精神病学科学的现状下，DSM - 5应采取谨慎、保守的姿态还是果断、变革的姿态这一问题；4）实用主义考量在DSM - 5编制中的作用；5）DSM的效用问题——DSM - III和IV是更多地为临床医生还是研究人员设计的，以及在新手册中应如何处理这一冲突；6）鉴于DSM - III和IV存在的所有问题，设计一个不同诊断系统的可能性和可取性。本文第一部分将探讨前两个问题。对于第一个问题，受邀评论者就精神疾病的本质表达了一系列观点，大致分为现实主义立场，即诊断类别代表真实疾病，我们能够凭借感知能力准确命名和了解；中间的唯名论立场，即精神障碍在现实世界中确实存在，但我们的诊断类别是构建物，可能准确也可能不准确地反映外部的障碍；最后是纯粹的建构主义立场，即诊断类别仅仅是构建物，现实世界中没有精神障碍的证据。第二个问题同样就我们应如何定义精神或心理障碍提供了一系列观点，包括我们不应试图制定定义的可能性。一般性引言以及针对具体问题的引言和结论由詹姆斯·菲利普斯撰写，对评论的回应由艾伦·弗朗西斯撰写。
