The attempt to catalog all the ways that Americans can go crazy dates at least to 1840, when the Census included a question on "idiocy/insanity." From those two simple categories, we now have more than 300 separate disorders; they are listed in a 943-page book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short.

This week we got the first comprehensive look at what might go into the book's latest version, the DSM-5. Currently, the DSM is disjointed and disorganized - at times well researched and at times anachronistic. The present version, the DSM-IV-TR (the TR stands for "text revision"), was published in 2000. It begins with "mild mental retardation" moves on to common illnesses like depression and odd ones like dyspareunia (painful sexual intercourse not due to a medical condition) and ends with the vague "personality disorder not otherwise specified." The rhyme and reason behind the DSM have always been murky; the book, like our brains, is a huge, complicated beast.

Details.

[So, given all the disagreements, how is psychiatry a legitimate forensic field, accurate enough for opinions in the courtroom? What weaknesses have you seen?]

[This message was edited by JB on 02-15-10 at .]

I think the existence of a severe mental disease can be pretty well determined, especially through study by an expert. Whether it prevented someone on a certain occasion from recognizing society would consider a certain act wrong,I believe, is likely beyond the expertise of any human being. Even the person experiencing the psychosis is unable to say, much less someone depending on what is learned from the psychotic person. A test developed 170 years ago may be in need of some revision. But as Professor Gross points out, "very difficult medical questions about which states of abnormality leave a person not in a responsible condition will remain," however the legal test is formulated. Changes in the DSM should not affect how the legal test is applied.