title: The six most essential questions in psychiatric diagnosis: a pluralogue part 2: Issues of conservatism and pragmatism 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 took up the first two questions. Part II will take up the second two questions. Question 3 deals with the question as to whether DSM-V should assume a conservative or assertive posture in making changes from DSM-IV. That question in turn breaks down into discussion of diagnoses that depend on, and aim toward, empirical, scientific validation, and diagnoses that are more value-laden and less amenable to scientific validation. Question 4 takes up the role of pragmatic consideration in a psychiatric nosology, whether the purely empirical considerations need to be tempered by considerations of practical consequence. As in Part 1 of this article, 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, 300 George St,, Suite 901, 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: D039721:Diagnostic and Statistical Manual of Mental Disorders; D004992:Ethics, Medical; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000523:psychology; D010686:Philosophy, Medical; D011570:Psychiatry / Q000295:instrumentation / Q000379:methods*; D011594:Psychometrics / Q000295:instrumentation / Q000379:methods*