Reforming psychiatry's DSM

August 24, 2001

Modern psychiatry has become mired in a system of disease classification that defines mental disorders by the way they look and not on biological or psychological processes, according to Paul R. McHugh, M.D., Henry Phipps Professor and chair of the Department of Psychiatry and Behavioral Sciences at the Johns Hopkins University.

Notably, McHugh's criticism and his proposed solution are featured in the current issue of Psychiatric Research Report, a publication of the American Psychiatric Association's Division of Research. [see article, available online at]

"This is not a weak challenge to contemporary psychiatry, but a strong one. That the APA would publish this, even if only to challenge itself, is quite a tribute to Johns Hopkins psychiatry," said McHugh.

The topic of contention is the fourth edition of the APA Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), an encyclopedic catalog used to consistently diagnose psychiatric diseases based on clinical symptoms.

But the focus on symptoms, rather than psychologic or biologic foundations, has led to thousands of overlapping conditions and confusing diagnoses, and the current system has become unwieldy and outmoded, according to McHugh.

"The DSM-IV approach was a solution to problems of the past. It brought reliability to the diagnosis of mental disorders, but the solution to problems of the past has become the problem of today," said McHugh.

McHugh proposes that the fifth edition of the DSM, slated for 2007, incorporate a conceptual structure for psychiatry that seeks to identify the essence of mental disorders as expressions of psychological life in a context of pathology and misdirection.

This approach, used at Hopkins for over 20 years, is based on four explanatory methods or perspectives: disease, dimension or psychological variation, behavior and life story. "I'm not saying this is the final solution; what I am saying is that solutions of this sort should be the subject of psychiatric attention and academic work," said McHugh.
To interview Paul McHugh, please call Trent Stockton at 410-955-8665 or email For more information on Johns Hopkins Department of Psychiatry and Behavioral Sciences visit: To learn more about "The Perspectives of Psychiatry" at Johns Hopkins School of Medicine visit:

Source: Psychiatric Research Report, Summer 2001 Paul R. McHugh, M.D. Director and Psychiatrist-in-Chief, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Medical Institutions, Baltimore Md.

"Beyond DSM IV: From Appearances to Essences"


TO: Editors, reporters, writers

DATE: August 23, 2001

Johns Hopkins Medicine

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