As most readers of this blog are well aware, the American Psychiatric Association will publish its latest version of the Diagnostic and Statistical Manual (the hallowed “DSM”) in 2013. The next version will be version 5. (Note, it’s “5,” not “V.” This is so that follow-up versions can be named 5.0.1, 5.1, 5.1.1, etc. Just like computer software. I kid you not.)
The provisional criteria have been made public, and the APA invites anyone to comment on its website, dsm5.org. (The full development process was not this transparent. Allen Frances and Robert Spitzer, two dissidents, famously decried the “nondisclosure agreements” the book’s authors had to sign. Spitzer even commented, “The intent seemed to be not to let anyone know what the hell was going on.”)
But as we get closer to the publication date, readers can have a closer look under the hood. Anyone can surf over to their website and make comments. Yes, now is your chance to let the leaders of the psychiatric profession know precisely what you think about the new “Somatic Symptom Disorder” diagnosis; challenge the possible removal of the “narcissistic” category; or just tell the authors that you think psychiatry is all a crock of s***.
In an interview published today on Medscape, David Kupfer, chair of APA’s DSM-5 task force, reports that this spirit of openness and flexibility will likely persist even after its publication. He says the upcoming DSM-5 will be a “living document,” complete with an electronic version (probably online?) which will be “much easier to update and may even include links to videos and vignettes.”
That could be a big step forward. Imagine: if you’ve never seen catatonia before, you might be able to click on the DSM-5 entry and see a video of a catatonic person. If your patient doesn’t understand why you just diagnosed her with borderline personality, you can read her a descriptive vignette (so much more interesting than a checklist!) and she’ll get it.
My thinking is, why stop there? Psychiatrists are already way behind the times when it comes to modern technology. Our peers in other specialties get to use fancy doodads like MRI scanners and bypass machines and stents all day long. We just sit around and talk to people.
And then it hit me: the APA should create a DSM-5 wiki.
For those of you who have no idea what a “wiki” is, it’s a website developed collaboratively by users and visitors. Any user can add content, and it’s edited in real time by other users. Disputes are resolved by online discussion, and historical changes can be viewed by anyone. Perhaps the most famous example of a wiki is Wikipedia, the online encyclopedia. Those articles were not first published in a book somewhere; instead, they have been written by experts and non-experts alike, and are constantly being edited. Wikipedia has, for better or for worse, come to replace conventional encyclopedias and is a remarkably accurate (and free) source of material.
Imagine the uses. A DSM-5 wiki would let clinicians chime in about what they think ought to be changed or added, like an interesting “subtype” of an existing disorder. Similarly, scientists could share findings that might be relevant to diagnosis (like newly discovered biomarkers) and clinicians could share novel uses of off-label medications, therapeutic successes, and interesting case reports.
Each medication could have its own Wiki page, with complete FDA approval information and dosing. Herbals could be included. To be fair, pharmaceutical companies would have free access to their documents, but any changes made by industry would be flagged as such. Users could even upload cost data to help patients find affordable generic alternatives.
But the APA needs to make an even stronger statement that we’re not just old guys sitting around smoking pipes. We need to go balls to the wall. We could allow users to upload videos of unique patient presentations (with the proper HIPAA safeguards in place, like black rectangles over patients’ eyes, etc), public-domain lectures by famous psychiatrists, and links to journal articles describing new and relevant findings. We could also add references to fascinating psychiatry blogs like this one. (lol)
Patients could also upload their own experiences, in YouTube format. Their videos would be cross-referenced to the relevant diagnoses and/or medications. Videos with the most “hits” could win a prize. Maybe we can link terms to their Urban Dictionary entries.
We could add clips from Hollywood movies depicting particular disease presentations. We could add links to Amazon.com to purchase relevant books (and use the Amazon Associates revenue to help manage server costs). We could include a Skype plug-in that would allow users to chat with other people logged on at the same time. We could even sell space to advertisers like Groupon (“10 sessions of psychotherapy for the price of 5 in Chicago!!”) or, for those over 21, porn sites (targeted specifically to readers of the “Paraphilias” entry).
Social media is the future, and the APA really needs to get with the program! An animated GIF logo. An MP3 theme playing in the background of each page. A Flash-based interface (sorry, iPad users). The APA could even create new, edgy slogans for itself and for the DSM. For instance, it’s not DSM-5 anymore, it could be “D5M-ph!\/3”. It’s not just a “living document,” it can be the most 4w3soM3 social media psychiatry destination on the planet! OMG!!!!!!1!
Let’s do it.