I know that the DSM is put out by the APA, so I would assume that it is mainly used in the US. Do other countries produce similar manuals or do they use a different approach?
DSM equivalent in other countries
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The DSM is increasingly used throughout the world although the ICD (International Classification of Diseases) is the major classification system outside North America although ICD-11 and DSM-V will be very much aligned. The chinese have their own - the Chinese Classification of Mental Disorders. Chinese psychiatrists tend not to diagnose depression for example, and a diagnosis of neuraesthenia is made instead. The expression of distress in many cultures is primarily somatic.
DSM diagnoses are constructions that lack validity (but the common ones are pretty reliable which means that 10 psychiatrists are likely to make the same diagnosis if they use the same criteria) and the cultural validity is a particular concern. We have been exporting western concepts of distress to other parts of the world and this has been regarded as a form of medical imperialism or psychiatric colonization where we see an increasing western hegemony in explanatory models of distress typically using a biomedical or psychological discourse where many cultures have moral or spiritual explanatory models.
One of the most glaring examples of inappropriately exporting western idioms of distress is the case of trauma and PTSD. There are many parts of the world where concepts of trauma and PTSD did not exist until well-intended psychiatrists and psychologists brought them and it is quite frankly an embarassment to the profession.
DSM diagnoses are constructions that lack validity (but the common ones are pretty reliable which means that 10 psychiatrists are likely to make the same diagnosis if they use the same criteria) and the cultural validity is a particular concern. We have been exporting western concepts of distress to other parts of the world and this has been regarded as a form of medical imperialism or psychiatric colonization where we see an increasing western hegemony in explanatory models of distress typically using a biomedical or psychological discourse where many cultures have moral or spiritual explanatory models.
One of the most glaring examples of inappropriately exporting western idioms of distress is the case of trauma and PTSD. There are many parts of the world where concepts of trauma and PTSD did not exist until well-intended psychiatrists and psychologists brought them and it is quite frankly an embarassment to the profession.
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ICD-10 blue book is what you're looking for, though a lot of the world outside the US does use the DSM.
http://www.who.int/classifications/icd/en/bluebook.pdf
http://www.who.int/classifications/icd/en/bluebook.pdf
I agree with you that much of the DSM is malarkey.
However, I don't think PTSD is the best example of exporting American psychiatric diagnoses. PTSD is a well understood biological phenomenon that most certainly exists in other countries whether it is diagnosed or not.
Now, the over-diagnosis of PTSD is a whole different topic . . .
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before the 1970s there was no concept of PTSD. Although some have pointed out that shellshock, railway spine, war neurosis and battle fatigue were forerunners to PTSD they are not the same. Phenomenologically shellshock etc was primarily somatic in nature whereas PTSD is typically characterized by re-experiencing phenomena. Flashbacks did not commonly occur in the past. Of course there is a biological basis to the experience of PTSD, but that doesn't mean it isn't a sociopolitical construct. There are many reasons why the diagnosis of PTSD and the rise of the trauma industry irk me, but none more so than the reification and globalization of PTSD.
Perhaps I am a hypocrite, but I have on occassion made a diagnosis of PTSD and treated with hypnosis and exposure therapy as I think it has some utility. But any anthropologist will tell you that trauma and PTSD are largely western constructions and there are different explanatory frameworks that are used in the rest of the world.
Allan Yong has written extensively on the invention of PTSD and deconstructed the biological narratives for hyperarousal and avoidant phenomena.
Perhaps I am a hypocrite, but I have on occassion made a diagnosis of PTSD and treated with hypnosis and exposure therapy as I think it has some utility. But any anthropologist will tell you that trauma and PTSD are largely western constructions and there are different explanatory frameworks that are used in the rest of the world.
Allan Yong has written extensively on the invention of PTSD and deconstructed the biological narratives for hyperarousal and avoidant phenomena.
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I think you're oversimplifying things. Shellshock and the rest likely included what we would consider PTSD today.
Shellshock was pirmarily somatic in nature because psychiatry was in its infancy as part of military medicine and the diagnosis of the phenomenon was typically made by physicians with little psych training. They primarily noted somatic issues related to shellshock because they were primarily trained to recognize and treat somatic disease.
As it stands today, outside of specific screens and benefit-seekers, PTSD is most often caught not by complaints of flashbacks but somatic symptoms. And many (most?) sufferers of PTSD do not report classic awake "flashbacks" as popularized in movies and film.
I'm with all of you that PTSD can be overdiagnosed. But convincing me that a survivor of Rwanda genocide or a rape victim in Laos do not re-experience the event through psychological/physiological reactions to reminders of the event or have nightmares about what they went through? I'm dubious.
I understand the hesitancy to apply "Western" constructs on the rest of the world, as it's a form of cultural ignorance. But I think you can bend over so far that you start entering the stereotype of the "stoic" people of color who don't suffer from the repercussions of trauma, which is another form of cultural ignorance.
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I think you are underselling the tremendous descriptive skill physicians of the past had compared to today. If you read case reports from 50 years ago, and before the level of detail and precision is rarely captured today. One only has to read Kraepelin, Bleuler, Jaspers and Schneider to see why they still have an oft overlooked influence on descriptive psychiatry today. In terms of psychological phenomena Freud obviously popularised the use of 'trauma' to describe a deep psychical wound, and Janet was interested in dissociation and its role in psychopathology. Even non-psychiatrically trained physicians were far better than many psychiatrists today at describing psychopathology. In the military much psychiatry fell to the neurologists and they did an excellent job. Medicine, and psychiatry as a branch of medicine, typically develops the most during wartime, and European psychiatry certainly made enormous strides during the great war, as did American Psychiatry during WWII such that psychiatry was not an unpopular specialty during the 1940s, partly due to the successes of treating soldiers with hypnosis and brief analytic therapies. As a side, such was the demand for psychiatrists during WWII it was possible for physicians to complete a psychiatry residency in 90 days!
My point is to suggest descriptive or diagnostic psychiatry was in its infancy in the early 20th century is not true. We have not really advanced in the right direction since that times (most of the advances have been made in basic science and therapeutics) and if anything psychiatry has been regressing with the vast proliferation of ill-conceived diagnoses that seek to confirm there is a psychopathology of everyday life. So if we were to examine military records (and this has been done) they would be fairly reliable indicator of what symptoms were being experienced. Flashbacks (archetypal of PTSD even if not necessary) was not commonly experienced. Shellshock etc is much more like conversion disorder or somatization disorders of today than it is PTSD as many psychiatrists have highlighted.
I do not for one moment want to underplay the deep psychological consequences of atrocious experienced lived through, in fact one of the reasons PTSD irks me is by wedding PTSD to trauma, we tend not attribute the importance of traumatic events in the etiology of other mental illnesses like schizophrenia, bipolar, depression etc. Acknowledging that people suffer because bad things happen to them however is not mutually exclusive from recognizing the complex context into which PTSD was invented. It made its way into the psychiatric nomenclature at a time when there was an extremely unpopular war, when the women's movement was highligting the tyranny women suffered at the hands of men and that the real battlefield for women was their own homes, when the psychoanalysts were being expunged from psychiatry, and when the term 'neurosis', 'reaction' or anything that ostesibly suggested a theoretical basis to psychiatry or etiology of a diagnosis was being removed from the DSM.
My point is to suggest descriptive or diagnostic psychiatry was in its infancy in the early 20th century is not true. We have not really advanced in the right direction since that times (most of the advances have been made in basic science and therapeutics) and if anything psychiatry has been regressing with the vast proliferation of ill-conceived diagnoses that seek to confirm there is a psychopathology of everyday life. So if we were to examine military records (and this has been done) they would be fairly reliable indicator of what symptoms were being experienced. Flashbacks (archetypal of PTSD even if not necessary) was not commonly experienced. Shellshock etc is much more like conversion disorder or somatization disorders of today than it is PTSD as many psychiatrists have highlighted.
I do not for one moment want to underplay the deep psychological consequences of atrocious experienced lived through, in fact one of the reasons PTSD irks me is by wedding PTSD to trauma, we tend not attribute the importance of traumatic events in the etiology of other mental illnesses like schizophrenia, bipolar, depression etc. Acknowledging that people suffer because bad things happen to them however is not mutually exclusive from recognizing the complex context into which PTSD was invented. It made its way into the psychiatric nomenclature at a time when there was an extremely unpopular war, when the women's movement was highligting the tyranny women suffered at the hands of men and that the real battlefield for women was their own homes, when the psychoanalysts were being expunged from psychiatry, and when the term 'neurosis', 'reaction' or anything that ostesibly suggested a theoretical basis to psychiatry or etiology of a diagnosis was being removed from the DSM.
