Limites et dangers des DSM

The publication of the DSM-III rating scale in 1980 marked a definite turning point in the development of modern psychiatry. For those responsible for elaborating it, it appeared to have resulted in psychiatry being accepted as a science. However, this was at the expense of eliminating the subjective aspect, both that of the patient and that of the clinical practitioner. As a result of this, it was possible to utilize a common language which permitted high inter-scoring diagnostic accuracy. The success of the DMS-III and IV is based on their affinity with scientific ideals, and with their association with clinical medication. In focusing on target symptoms devoid of all dynamism, they implicitly relate them to bodily dysfunctions. Twenty years after the introduction of this approach presented as being atheoretical, its main justification, i.e. diagnostic accuracy, has been shown to be ill-founded, while the problems of diagnostic validity are eluded. The DSM scales have relegated mental disorders to being infinitized, and the pursuit of this approach could eventually lead to treatment by computerized psychiatry. These rating scales also lead to an impoverishment of clinical consultations; they do not take into account the possible reticence of the patient; and they generate implicit normative ideals. Even amongst their proponents, certain individuals are beginning to see that they could constitute a serious disadvantage to the progress of psychiatry.