My introduction to social work began during the days of the
D.S.M.-III. I remember that D.S.M. as though it were
yesterday. It was like a citrus grove filled with lemons and
oranges, just oozing with Vitamin C. It provided such good
nutrition for the dedicated worker and eternal student.
For those who
may have never seen the D.S.M.-III, I'm referring to the color
of its cover--bright yellow-green. And, of course, D.S.M. is
short for Diagnostic and Statistical Manual of Mental
Disorders. It's the book which we mental health workers use
to officially diagnose our patients and thereby obtain
insurance reimbursement. The D.S.M. has a definite practical
use. But does it have any other value?
It seems there
have always been polarized views regarding the D.S.M. Some
people find it a useful tool that gives us a common clinical
language and diagnostic categories so that we can communicate
with one another. Others find it a constraining system that
unnecessarily and inaccurately labels our patients.
When I first
opened the D.S.M.-III back in the 1980's, it gave me safe
passage into a new world. I thrived on studying lists of
symptoms and learning how to make a differential diagnosis.
I longed to own copies of the D.S.M.-I and D.S.M.-II. I
searched in the used bookstores, asked my co-workers, but
nobody had ever seen the 'I' and 'II' versions. And nobody
was interested. I was looked upon as an anomaly. What did I
care! I was feeding myself a delicious intellectual food
which I picked from the lush foilage of my citrus grove.
D.S.M.-III-R was published. Oh, goody goody! More diagnostic
treats! I rushed right out to buy the paperback version and
its matching Casebook. Although, rather expensive, I'll
admit. The color of the D.S.M.-III-R was ocean-blue. Its
contents were like rare proteins in the midst of plentiful
waters. It held exotic wonders for my adventuresome mind.
How I loved to splish and splash in its depths.
Let me take a
moment to give you the time-frame for all the D.S.M.'s. The
D.S.M. has been around for fifty-two years. Here's when each
one was published:
That's a lot of
D.S.M.'s. By the time the D.S.M.-IV was published, I began to
feel the financial burden. For the first time, I did not buy
my own copy to study and cherish. I began using the workplace
copy to simply flip through the pages and look up diagnostic
code numbers for which my memory had no capacity. Besides, the
cover of the D.S.M.-IV was a deep burgundy. It was unexciting
from the beginning. Burgundy is the color of wine: very
inappropriate, don't you think? I became nostalgic for my
youthful days of ocean-blue and yellow-green.
color-sensitive people like myself, the burgundy model had a
short lifespan. In a mere six years it was gone. The next
D.S.M. was destined to outshine the whole bunch.
sped in like a sleek, silver sports car. Breathtaking beauty.
A cure for the mid-life crisis. Just what I needed to make
me wipe the smudges off my eyeglasses and start studying
again. Yes, I can see clearly now.
I see, for
example, as I'm sure you do too, that despite improvements,
human emotions are difficult to categorize neatly. I am
already looking forward to the D.S.M.-V. We desperately need
diagnostic categories for co-dependency, chronic anger,
cross-addiction, and hoarding. There are experts in these
fields who have made worthy contributions to our knowledge, and
I hope their voices will be heard at the D.S.M.-V editing
table. Who knows, if the color is right, I might even buy my
own paperback copy. (Written 04/07/03 - Revised: 12/01/03,
11/05/07: bibliography available.)
Until we meet