title: The six most essential questions in psychiatric diagnosis: a pluralogue part 1: conceptual and definitional issues in psychiatric diagnosis.
abstract: 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.
authors.affiliation: Department of Psychiatry, Yale School of Medicine, New Haven, CT 06511, USA. james.phillips@yale.edu
authors.forename: James
authors.initials: J
authors.lastname: Phillips
authors.forename: Allen
authors.initials: A
authors.lastname: Frances
authors.forename: Michael A
authors.initials: MA
authors.lastname: Cerullo
authors.forename: John
authors.initials: J
authors.lastname: Chardavoyne
authors.forename: Hannah S
authors.initials: HS
authors.lastname: Decker
authors.forename: Michael B
authors.initials: MB
authors.lastname: First
authors.forename: Nassir
authors.initials: N
authors.lastname: Ghaemi
authors.forename: Gary
authors.initials: G
authors.lastname: Greenberg
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Hinderliter
authors.forename: Warren A
authors.initials: WA
authors.lastname: Kinghorn
authors.forename: Steven G
authors.initials: SG
authors.lastname: LoBello
authors.forename: Elliott B
authors.initials: EB
authors.lastname: Martin
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Mishara
authors.forename: Joel
authors.initials: J
authors.lastname: Paris
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Pierre
authors.forename: Ronald W
authors.initials: RW
authors.lastname: Pies
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pincus
authors.forename: Douglas
authors.initials: D
authors.lastname: Porter
authors.forename: Claire
authors.initials: C
authors.lastname: Pouncey
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schwartz
authors.forename: Thomas
authors.initials: T
authors.lastname: Szasz
authors.forename: Jerome C
authors.initials: JC
authors.lastname: Wakefield
authors.forename: G Scott
authors.initials: GS
authors.lastname: Waterman
authors.forename: Owen
authors.initials: O
authors.lastname: Whooley
authors.forename: Peter
authors.initials: P
authors.lastname: Zachar
mesh_terms: D003210:Concept Formation; D039721:Diagnostic and Statistical Manual of Mental Disorders; D006801:Humans; D001523:Mental Disorders / Q000145:classification* / Q000175:diagnosis*