10


taxonomies of psychopathology variety. All diagnostic categories allow for unspecified identification of clinical presentations that are characteristic of a given disorder type. This added diagnostic flexibility, the new possibility of ranking, and the reorganization of the book into three parts: an introduction with instructions, a classification of mental illnesses, and new areas of study and de- velopment, the DSM-5 aims at prospective generalizability and universality. The DSM-5 goes to new lengths to achieve international applicability and standardization with the International Classification of Diseases (ICD); the new DSM edition gives a full nu- merical listing of diagnostic codes for both ICD 9 and the anticipated ICD 10. The elimi- nation of the multiaxial system is another major change to DSM-V from the preceding version. The axial system had been in ef- fect since DSM-3, implemented in an effort to give attention to the whole pathological state of some clinical case-types. For exam- ple Axes IV (Psychosocial and Environmental Problems) was used to note environmental stressors and factors that may have influ- enced the etiology of some pathology, or been brought about by it. As such the con- sideration of causation has been incorpo- rated into the primary process of diagnostic interpretation.


Many therapists will rightly discern a ten- sion in the larger profession, when that which is defined as a mental health problem is further medicalized, the role of coun- selling, talk therapy, and meaning making


VOL. 45 NO. 4 | FALL 2013


becomes more tentative. Counsellors and psychotherapists work through the distinc- tions between mind and body; thereby provoking new ways of understanding and theorizing. The DSM-5 troubles therapists because the diagnostic and statistical purpo- sive aspects of the manual have been read to infer certain actual groupings between diseases, composing syndrome clusters, and suggested treatments; however, the DSM-5 does no such thing. The DSM-5 should not be confused for a theoretical or treatment guideline. The purpose of the book is to be practical, a reference tool. As such the diag- nostic book must be accessible to members of the broader community. The DSM-5 intro- duces an added dimensional aspect in case formulation. By eliminating the multi-axial system the DSM-5 has opened the way for phenomenological approaches to a topo- graphic layering of clinical presentations and description. For example, following the DSM-IV ‘Outline for Cultural Formulation and Cultural-Bound Syndromes’, where an approach was sketched to examine the way that culture was impactful upon a present- ing clinical episode, the DSM-5 introduces an actual and comprehensive formulation whereby the clinician is aware of their own role in meaning-making and disease classifi- cation identification. In credit to the authors of the DSM-5, in no other field of science is any system of classification as hotly debated and provocative as the one in the profes- sional disciplines of psychology, mental health, and counselling.


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