University of Kentucky Mental Health Research Center, Eastern State Hospital, Lexington, KY, Estados Unidos; Psychiatry and Neurosciences Research Group (CTS-549), Institute of Neurosciences, University of Granada, Granada, España.
Rev Psiquiatr Salud Ment. 2014 Oct-Dec;7(4):186-94. doi: 10.1016/j.rpsm.2013.12.004. Epub 2014 Jan 31.
The Diagnostic and Statistical Manual of Mental Disorders (DSM-III), published in 1980, has led to a dead end, the DSM-V. Following the allegory of Sleeping Beauty, the DSM-III put European psychiatry to sleep; it now must wake up to create a 21st century psychiatric language for descriptive psychopathology and psychiatric nosology. Four topics are reviewed. First, the review of descriptive psychopathology focuses on: a) Chaslin's and Jaspers's books, and b) Schneider's transmittal of Jaspers's ideas and involvement with Kraepelin in incorporating neuroscience into psychiatric nosology. Second, US psychiatry's historic steps include: a) the pseudoscience of psychoanalysis, b) the low level of pre-DSM-III diagnostic expertise, c) the neo-Kraepelinian revolution which led to DSM-III, d) the failure to improve diagnostic skills, and e) the reprise of Kraepelin's marketing ("neuroscience will save psychiatry"). Third, the DSM-III devastated European psychiatry by destroying: a) the national textbooks which increased consistency but eliminated creative European thinking; and b) the Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie, the most reasonable attempt to reach diagnostic agreement: start with symptoms/signs (first level) rather than disorders (second level). Fourth, Berrios elaborated upon Jaspers, who described psychiatry as a hybrid science and heterogeneous. Berrios affirmed that psychiatric symptoms/signs are hybrid. Some symptoms are in the "semantic space" and cannot be "explained" by neuroscience.
《精神障碍诊断与统计手册》(DSM-III)于 1980 年出版,导致了 DSM-V 的出现。就像《睡美人》的寓言一样,DSM-III 让欧洲精神病学陷入了沉睡;现在它必须醒来,为描述性精神病理学和精神疾病分类学创造一种 21 世纪的精神科语言。本文回顾了四个主题。首先,描述性精神病理学的回顾重点关注:a)Chaslin 和 Jaspers 的著作,以及 b)Schneider 对 Jaspers 思想的传递以及与 Kraepelin 合作将神经科学纳入精神疾病分类学。其次,美国精神病学的历史步骤包括:a)精神分析的伪科学,b)DSM-III 前诊断专业知识水平低,c)导致 DSM-III 的新 Kraepelin 革命,d)未能提高诊断技能,以及 e)Kraepelin 营销策略的再现(“神经科学将拯救精神病学”)。第三,DSM-III 通过摧毁:a)增加一致性但消除了创造性的欧洲思维的国家教科书;以及 b)Arbeitsgemenschaft fur Methodic und Dokumentation in der Psychiatrie,这是达成诊断共识的最合理尝试:从症状/体征(一级)而不是疾病(二级)开始。第四,Berrios 对 Jaspers 进行了阐述,Jaspers 将精神病学描述为一种混合科学和异质科学。Berrios 肯定了精神科症状/体征是混合的。有些症状处于“语义空间”,无法用神经科学“解释”。