A rock star of psychiatry
Dr. Robert Spitzer, father of DSM3, is profiled in the current New Yorker. Most of my residency was spent memorizing his work, and trying to apply it in the clinic. Funny thing...the author makes connections between Dr. Spitzer's personality and his contributions to the field. Both are described as rather concrete, and lacking in emotional awareness. Does it all seem a bit facile?
I do admire his work. I can't imagine practicing without it. But the article states that we have endowed the DSM with authority that it doesn't quite deserve. These diagnoses really were banged out in committee. Sometimes the loudest voice prevailed.
The product of this committee work - "all in favor of the criteria for post-traumatic stress, say aye" (especially if the man in charge agrees) - organizes our thinking, when we make diagnoses and select treatments. It will always be a work in progress, and we need to be clear about that when we work with patients. (One of my most-repeated lines: "In the year 2004, this is how psychiatrists in America would diagnose your condition, based on these criteria.") One benefit of the DSM3: it enabled us to define groups of patients that we could study, and see if any of our diagnoses and treatments were helpful.
The article says that patients don't tend to challenge DSM diagnoses. The author must not be from around here! Almost everyone challenges us about everything, as well they should.
True story: I talked to Dr. Spitzer once. Really! I was a new intern, starting out. I was looking for a questionnaire that was cited in a journal. My search was going nowhere. I decided to phone the author of the article and ask him about it. "Hello...Is Dr. Spitzer there?"
Senior residents heard me and started to panic. "Do you know who you're talking to??!" they hissed. I had no idea, really, but as the pandemonium grew, it started to dawn on me. It was as though I had dialed the White House and asked to talk to the president.
But he was very nice to me. He explained the reference, and gave some pointers on how to find it. I had spoken with the rock star of psychiatry! (No glamour rubbed off on me, though...)
It's too bad I was so clueless that day. If I could talk to him today, I would have so many questions. Then again, only the greenest of interns would have called him in the first place.
I do admire his work. I can't imagine practicing without it. But the article states that we have endowed the DSM with authority that it doesn't quite deserve. These diagnoses really were banged out in committee. Sometimes the loudest voice prevailed.
The product of this committee work - "all in favor of the criteria for post-traumatic stress, say aye" (especially if the man in charge agrees) - organizes our thinking, when we make diagnoses and select treatments. It will always be a work in progress, and we need to be clear about that when we work with patients. (One of my most-repeated lines: "In the year 2004, this is how psychiatrists in America would diagnose your condition, based on these criteria.") One benefit of the DSM3: it enabled us to define groups of patients that we could study, and see if any of our diagnoses and treatments were helpful.
The article says that patients don't tend to challenge DSM diagnoses. The author must not be from around here! Almost everyone challenges us about everything, as well they should.
True story: I talked to Dr. Spitzer once. Really! I was a new intern, starting out. I was looking for a questionnaire that was cited in a journal. My search was going nowhere. I decided to phone the author of the article and ask him about it. "Hello...Is Dr. Spitzer there?"
Senior residents heard me and started to panic. "Do you know who you're talking to??!" they hissed. I had no idea, really, but as the pandemonium grew, it started to dawn on me. It was as though I had dialed the White House and asked to talk to the president.
But he was very nice to me. He explained the reference, and gave some pointers on how to find it. I had spoken with the rock star of psychiatry! (No glamour rubbed off on me, though...)
It's too bad I was so clueless that day. If I could talk to him today, I would have so many questions. Then again, only the greenest of interns would have called him in the first place.
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