title: Seeking Legitimacy for DSM-5: The Bereavement Exception as an Example of Failed Process.
abstract: In 2013 the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Even before publication, DSM-5 received a torrent of criticism, most prominently over removal of the "bereavement exclusion" for the diagnosis of major depression. We argue that while the APA can claim legitimate authority for deciding scientific questions, it does not have legitimacy for resolving what is ultimately a question of ethics and public policy. We show how the "accountability for reasonableness" framework for seeking legitimacy in health policy could have been used to achieve a better resolution of the conflict than actually occurred.
authors.affiliation: Clinical professor in the Departments of Population Medicine and Psychiatry at Harvard Medical School in Boston and director of the ethics program at Harvard Pilgrim Health Care, a not-for-profit regional health services program, and a fellow of the Hastings Center and a member of the American Medical Association Council on Ethical and Judicial Affairs.
authors.forename: James E
authors.initials: JE
authors.lastname: Sabin
authors.affiliation: Mary B. Saltonstall Professor and a professor of ethics and population health in the Department of Global Health and Population at the Harvard T.H. Chan School of Public Health in Boston.
authors.forename: Norman
authors.initials: N
authors.lastname: Daniels
mesh_terms: D001601:Bereavement; D001675:Bioethics; D003865:Major Depressive Disorder / Q000175:diagnosis*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D034462:Dissent and Disputes; D026690:Ethics, Clinical; D006117:Grief; D006291:Health Policy; D006801:Humans; D011570:Psychiatry / Q000941:ethics*; D012586:Science; D012941:Social Responsibility; D012955:Societies, Medical