December 30, 2004

To The New Yorker

(published February 7, 2005)

Unreliability in psychiatric diagnosis is “still a real problem, and it’s not clear how to solve the problem,” laments former Diagnostic and Statistical Manual of Mental Disorders editor Robert Spitzer to writer Alix Spiegel (“The Dictionary of Disorder,” January 3 rd). The first steps toward a solution are very clear. A big part of the problem is that the manual presents diagnosticians with a choice of almost 300 minutely differentiated mental illness classifications. Probably no clinician would be competent to identify and treat hundreds of truly discrete diseases.

The American Psychiatric Association needs to winnow the list by lumping similar mental health problems together. We are in an era when measurement, consistency of practice, and documentation guide both quality assurance and financial control in health care. The discipline of psychiatry needs to demonstrate it can play by these rules.

Neil Weisfeld
11 Coventry Circle
Princeton NJ 08540