Comments on "cyclical swings" by Professor Hannah Decker: The underappreciated "solid center" of psychiatry.

The history of psychiatry is characterized by some deep ideological and conceptual divisions, as adumbrated in Professor Hannah Decker's essay. However, the schism between "biological" and "psychosocial" models of mental illness and its treatment represents extreme positions among some psychiatrists-not the model propounded by academic psychiatry or its affiliated professional organizations. Indeed, the "biopsycho-social model" (BPSM) developed by Dr.

Mind-language in the age of the brain: is "mental illness" a useful term?

The term "mental illness" has been criticized on a variety of grounds, most notably by those who have argued that the term is merely a "myth" or a "metaphor." Some have argued that if and when so-called mental illnesses are exhaustively explained by disturbed brain function or structure, we will no longer need the term "mental illness," on the supposition that neuropathology and psychopathology are mutually exclusive constructs. The author argues that, on the contrary, the locution "mental illness" is not rendered useless or unnecessary when neuropathology is discovered, nor is the term "mental illness" a metaphor.

The Bereavement Exclusion and DSM-5: An Update and Commentary.

The removal of the bereavement exclusion in the diagnosis of major depression was perhaps the most controversial change from DSM-IV to DSM-5. Critics have argued that removal of the bereavement exclusion will "medicalize" ordinary grief and encourage over-prescription of antidepressants. Supporters of the DSM-5's decision argue that there is no clinical or scientific basis for "excluding" patients from a diagnosis of major depression simply because the condition occurs shortly after the death of a loved one (bereavement).

Bereavement: course, consequences, and care.

This paper discusses each of several potential consequences of bereavement. First, we describe ordinary grief, followed by a discussion of grief gone awry, or complicated grief (CG). Then, we cover other potential adverse outcomes of bereavement, each of which may contribute to, but are not identical with, CG: general medical comorbidity, mood disorders, post-traumatic stress disorder, anxiety, and substance use.

Grief, depression, and the DSM-5.

Based on a review of the best available evidence and the importance of providing clinicians an opportunity to ensure that patients and their families receive the appropriate diagnosis and the correct intervention without necessarily being constrained by a somewhat arbitrary 2-month period of time, the DSM-5 Task Force recommended eliminating the "bereavement exclusion" (BE) from the diagnosis of major depressive disorder. This article reviews the initial rationale for creating a BE in DSM-III, reasons for not carrying the BE into DSM-5, and sources of continued controversy. The authors argue that removing the BE does not "medicalize" or "pathologize" grief, "stigmatize" bereaved persons, imply that grief morphs into depression after 2 weeks, place any time limit on grieving, or imply that antidepressant medications should be prescribed.

The six most essential questions in psychiatric diagnosis: a pluralogue. Part 4: general conclusion.

In the conclusion to this multi-part article I first review the discussions carried out around the six essential questions in psychiatric diagnosis - the position taken by Allen Frances on each question, the commentaries on the respective question along with Frances' responses to the commentaries, and my own view of the multiple discussions. In this review I emphasize that the core question is the first - what is the nature of psychiatric illness - and that in some manner all further questions follow from the first. Following this review I attempt to move the discussion forward, addressing the first question from the perspectives of natural kind analysis and complexity analysis.

Are antidepressants effective in the acute and long-term treatment of depression? Sic et Non.

The efficacy of antidepressant treatment of major depression remains a matter of controversy. A review of acute treatment studies suggests that for relatively more severe episodes of major depression, antidepressants are superior to treatment in the "placebo group;" however, there are numerous methodological confounds in the available literature. (Some recent, preliminary evidence suggests that antidepressants may also be of benefit in some less severely depressed populations).

Bereavement, complicated grief, and the rationale for diagnosis in psychiatry.

Recent controversies over the DSM-5 raise a foundational question for all diagnostic classifications: what is their underlying purpose? The author raises this question in the context of the proposed elimination of the "bereavement exclusion" from the DSM-5; and the possible addition of the category called "Complicated Grief." The author argues that our psychiatric diagnostic scheme should not be aimed primarily at establishing boundaries among putative "natural types." Rather, it ought to be guided by the principle of "instrumental validity, " which focuses on reducing the suffering and incapacity of those who seek our care.

The six most essential questions in psychiatric diagnosis: a pluralogue part 3: issues of utility and alternative approaches in psychiatric diagnosis.

In face of the multiple controversies surrounding the DSM process in general and the development of DSM-5 in particular, we have organized a discussion around what we consider six essential questions in further work on the DSM. The six questions involve: 1) the nature of a mental disorder; 2) the definition of mental disorder; 3) the issue of whether, in the current state of psychiatric science, DSM-5 should assume a cautious, conservative posture or an assertive, transformative posture; 4) the role of pragmatic considerations in the construction of DSM-5; 5) the issue of utility of the DSM - whether DSM-III and IV have been designed more for clinicians or researchers, and how this conflict should be dealt with in the new manual; and 6) the possibility and advisability, given all the problems with DSM-III and IV, of designing a different diagnostic system. Part 1 of this article took up the first two questions.