Wednesday, March 20, 2013

Psychiatrist's Letter to the Editor Prompts Dialogue on Diagnosis

In a letter to the editor published in Tuesday's New York Times, psychiatrist Ronald Pies, M.D., took issue with critics who view psychiatric diagnoses as the equivalent of "myths" or "socially constructed labels." Troubled by controversy generated by critics of DSM-5, the next edition of APA's Diagnostic and Statistical Manual of Mental Disorders, to be published in May, Pies points out that, "Critics typically reply that other medical specialties have 'objective' criteria for diagnosis of disease, whereas psychiatrists merely apply 'labels' to behaviors they (or society) find offensive. But in truth, numerous medical and neurological diagnoses, such as migraine headache, are based on the same type of data that psychiatrists use: the patient’s history, symptoms and observed behaviors. I believe that psychiatric diagnoses are castigated largely because society fears, misunderstands and often reviles mental illness."

"Diagnosis," he emphasized, "means knowing the difference between one condition and another. For many patients, learning the name of their disorder may relieve years of anxious uncertainty. So as long as diagnosis is carried out carefully and respectfully, it may be eminently humanizing. Indeed, diagnosis remains the gateway to psychiatry's pre-eminent goal of relieving the patient's suffering." Pies is a professor of psychiatry at SUNY Upstate Medical University and Tufts University.

In response to Pies' letter, the Times has invited readers to respond to the issue he raised by Thursday, March 21, and plans to publish responses and a rejoinder from Pies in its Sunday Review section. Responses should be e-mailed to

In a joint statement to Psychiatric News, APA President Dilip Jeste, M.D., and President-elect Jeffrey Lieberman, M.D., strongly urge APA members to respond to the Times' invitation. “We want to call your attention to the excellent letter from Dr. Ron Pies that was in yesterday's New York Times, as well as the editors' invitation to establish a dialogue on DSM diagnoses with psychiatrists to be published in the Sunday Times. We encourage APA members to take this opportunity to inform and educate readers about the nature of mental illnesses described in DSM. By responding in this way, we hope that you will convey to readers the importance and value of DSM-5 in serving the needs of mental health care providers and patients with mental illness around the world.”

 Read Pies letter to the editor here.

(image: Stuart Monk/


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