Thursday, September 17, 2009

Jerry Maguire on DSM-V

Here is the presentation of Jerry Maguire at IFA 2009. I took the freedom to comment each slide. Jerry can of course comment if he wants.

TOM: I would not have mentioned the autoimmune component. It is Jerry's idea. Might be valid, might not be valid. But it is not an accepted fact, and should not be part of a discussion for DSM V.

Here is what wiki says about the classification structure:
The DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability:
Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders
Axis II: underlying pervasive or personality conditions, as well as mental retardation
Axis III: acute medical conditions and physical disorders
Axis IV: psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children and teens under the age of 18

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, autism, phobias, and schizophrenia.

Common Axis II disorders include personality disorders: paranoid personality disorder, schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant personality disorder, dependent personality disorder, obsessive-compulsive personality disorder, and mental retardation.

Common Axis III disorders include brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders.


TOM: The 9th criterion is reasonable, but the symptom as such is not easily observable. I would definitely not talk about feared speaking situations, because many fluent people have feared speaking situations. We need to talk about fear of stuttering in speaking situations, and fear of stuttering on certain speech utterances like words or syllables. Placing close to other speech / movement disorders is reasonable, too.

TOM: I completely agree with acquired stuttering being placed in Axis III. But I do not agree with psychogenic. Either it is neuro-biological or not. So for the extreme cases I would rather put it in Axis II with personality disorders. OR, maybe best label as a phobia? Actually, it might well be a phobia. A phobia to stutter even though the speech system is perfectly fine. And a technique like flooding should get rid of it.

TOM: I am not so sure about basal ganglia disorder. I have the impression basal ganglia is fine, but has to deal with bad neurology and so is in a sense dysfunctional due to input/output at best. But in the other disorders the basal ganglia has an issue.

TOM: I am highly supportive of the neurobiological basis of stuttering, but we cannot view the disorder of stuttering as only a disorder of neurobiology. As I say in my talk, we are biopsychosocial beings and stuttering is the prime example of how a neurobiological instability is blown out of proportion into a condition with strong psycho and social dynamics from a normal brain controlling a good part of the symptoms and associated handicap. So behaviouralists and other psychologists are relevant, especially if we cannot cure the bio part. At best we get smoothen out the bio with psychopharmacology.

TOM: Here I disagree with Jerry. It is not just social anxiety and avoidance. I am convinced that learned associations from classical and operand conditioning contribute towards the occurrence of dysfluencies and shape the content of all secondary symptoms. We should not forget them.

TOM: What would be the alternative to Axis I?

TOM: Money, money, money.

TOM: What is the difference between cognition and thought? I think we don't like the label psychiatric because we feel that our I is not impacted by stuttering. It is the periphery; the printer or screen is flickering but not the computer itself. Unlike depression, schizophrenia, bipolar.

TOM: We are very different to people with depression, bipolar, panic or schizophrenia. It is a fact that cannot be denied, and stating it clearly is just about pointing out the obvious. If the consequences are negative for others, it is not our problem what it is.We can also not state that Darwinian evolution is bogus just in order not to upset religious fanatics.

TOM: I do not mind being on Axis I as long as it is close to other periphery conditions like la Tourette. What about deafness or hearing difficulties? Is it in Axis I? Or not part of DSM?


Anonymous said...


My question is off-topic, but what is your opinion of Geoff Beach's therapy, which apparently involves looking at geometric shapes?

Anonymous said...

What about your second workshop at BSA: Evidence-based Interventions: How Good is the Evidence?