Abstract
This is the second edition of a popular book by Dr. Joel Paris: The Intelligent Clinician’s Guide to the DSM-5. The first edition appeared in 2013 and this second edition in 2015. The book is divided into 3 sections: 1) Principles, 2) Specific Diagnoses, and 3) a final section called Overview. The second section is by far the largest, covering the content of the various DSM-5 chapters. The Overview section has been updated and enlarged since the first edition, covering topics such as the reception of DSM-5 (something that could not be covered in the first edition due to the timing of its publication) and including suggestions for future revisions. The text spans 227 pages, excluding references and index.
It is perhaps necessary to first comment on the title of the book and its reference to the “intelligent clinician.” After reading the book, I think that I can deduce the meaning. Polarized debates on the DSM-5 can be quite fascinating, but they are not really what an intelligent clinician wants to know about. Paris describes himself as being neither a supporter nor detractor of the DSM-5. As such, the book is neither a polemic attack nor an endorsement. The intelligent clinician needs to assign diagnoses, interact with colleagues, teach, and make clinical decisions. Ignoring the DSM-5 is not really an option. Yet, being too strongly guided by the manual could easily be problematic. The intelligent clinician wants to know how to deal with the DSM-5. Quoting again from the book, “We have to use DSM-5, but we need to work our way around it” (p. 44). Near the end, advice is offered: “My advice is to work with the current criteria as much as possible but to decline to apply them rigidly where they do not make sense” (p. 226).
While the author provides references for assertions that draw upon evidence, opinions are also freely and directly expressed. This makes for a colorful read. For example, the concept of harmful dysfunction (which seems at least partially incorporated into the general definition of a mental disorder in the DSM-5) is described as a way to cut a particular Gordian knot entangling normal emotional changes with psychopathology. Expansion of the domain of psychopathology at the expense of normality (which Paris perceives to have occurred in each successive edition of the DSM) is described as a form of “mission creep.” Some otherwise puzzling Task Force decisions are described as emerging from the notorious “group think” dynamic.
The book adopts a humble tone when referencing the challenges faced by psychiatry in its current state of knowledge (e.g., quoting Frances and Egger [1999], “We are at the epicycle stage of psychiatry where astronomy was before Copernicus and biology before Darwin” [p. 83]). The emphasis here is not on what the DSM-5 Task Force and its working groups should have done differently in constructing the revision. Rather, the emphasis is on the impossibility of a perfect nosology given our current state of knowledge—and the clinical implications of this. However, Paris is clearly annoyed with the overinclusiveness of some diagnostic categories and with the contemporary emphasis on biological therapeutics.
A proviso about this book is that it is targeted to a large extent to the general adult psychiatrist. Some sections (e.g., depressive disorders, bipolar disorders, personality disorders) are covered in much more detail than others. A geriatric psychiatrist, for example, will find only a few pages on neurocognitive disorders. Sleep-wake disorders are covered in less than 1 page. As such, it should not be regarded as an encyclopedic source of information on the revision. Rather, this is a readable guide (Paris borrows here from Maimonides, p. 222) “for the perplexed.”