Psychiatry and the 21st Century: Reworking the DSM

After a long and torturous path, an elusive quest for structure and order may have misled the American Psychiatric Association to overexpand the scope of its Diagnostic and Statistical Manual (DSM) codification of mental disorders. The DSM and guidelines came to represent American psychiatry to the world. Although important for epidemiological and statistical research, in volume and complexity, the DSM challenges clinicians. The DSM effort at categorization must be reconceived to acknowledge modern biological realities. Molecular and other selective biological sciences no longer dominate biology as they did at the time of DSM's initial conception. Today, a Darwinian-Hippocratic combined biology leads psychiatry to address individuals and populations irretrievably and uniquely interdependent with environments. Unfortunately, the DSM, as currently conceived, fails to support this emerging 21st century biological grounding for psychiatry.