Oliver Matthes

“The Madness of Normality” – On why the DMS-5 is fundamentally wrong

The DSM (Diagnostic and Statistical Manual of Mental Disorders) is the world widely recognized classificatory system of psychiatric disorders, published by the American Psychiatric Association (APA). It is currently under major revision; the release version DSM-5 is expected in May 2013. The “psychiatrist´s bible“ has overwhelming impact: Inclusion in the DSM carries weight far beyond the psychiatrist’s office. It has major influence on whether insurers will cover therapy for a condition, whether research will be pursued for a specific disease or whether the health technology assessment agencies will approve medications that can be marketed for it.

Many interesting issues in DSM-5 could be discussed: the prevailing categories “substance abuse” and “dependence” will be substituted by “addiction and related disorders”, gender and ethnicity specific distinctions will we introduced and instead of distinguishing different entities like “Autistic disorder” or “Asperger´s disorder”, the manual introduces the term “Autism spectrum disorder”.

In this blog post, I want to focus on one particular innovation: The introduction of so-called risk syndromes. This is a collective term for all those conditions, which do not “yet” meet the “full” clinical diagnostic criteria, e.g. for schizophrenia: In this case, you would suffer from the “attenuated psychotic syndrome”. The aim is obvious: “Young people at risk for later manifestation of a psychotic disorder can be identified“. (http://www.dsm5.org/ProposedRevision/Pages/proposedrevision.aspx?rid=412#). This is a clear paradigm shift towards early diagnosis and prediction in psychiatry. Is this shift ethically justified?

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“Tourists are ambassadors in bathing suits” – On the ethics of choosing a holiday destination

Michael Allmaier, an Austrian journalist, wrote a controversial article in the German newspaper “Die Zeit” (http://www.zeit.de/2011/26/Reiseziele). It is devoted to the question, on why to pick an “ethical” holiday destination. He claims, that tourists should have a political attitude towards choosing a country to travel to. This inspired me to write this post on the ethics of selecting a holiday destination:

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