The Dynamics of Diagnosis A review of Psychodynamic Diagnostic Manual (PDM), by the PDM Task Force, Silver Spring, MD, 2006, 857 pp.
Review by: Naemi Stilman, M.D.
I confess that my initial reaction upon hearing of the Psychodynamic Diagnostic Manual (PDM) was one of indifference and dismissiveness. What would be the point, I reflected, of having a parallel system of diagnosis that could not be used practically, that is, for billing purposes or for communication with other medical or clinical specialties? Unlike many of my colleagues, I had always been very comfortable with, even in some ways admiring of, the Diagnostic and Statistical Manual-III (DSM-III)(American Psychiatric Association, 1980) and its successors (American Psychiatric Association, 2000). I have always liked its phenomenological, atheoretical approach to diagnosis, its clarity and utility. For those of us who began clinical work or study in the pre-DSM era, the DSM was a breath of fresh air. Yes, it entailed a medicalization of psychiatric diagnosis, but its conformity to the International Classification of Diseases (ICD) gave it a stamp of legitimacy and eased communication with nonpsychiatric colleagues. I should disclose that I trained and became board certified in internal medicine before training as a psychiatrist, child and adolescent psychiatrist, and adult and child psychoanalyst; I have always wanted psychiatry to be a full child, not a stepchild, of medicine.
That said, as a practicing psychoanalyst and psychodynamically oriented child and adult psychiatrist/therapist, I have found the DSM of limited use in how I actually practice, in how I think about and construct formulations about my patients, and in my supervision of junior colleagues on their long-term therapy cases. Like other analytically trained clinicians I know, I use a combination of specific theory, general psychoanalytic and psychodynamic principles, and knowledge based on study and experience, inference, intuition, and common sense in how I actually understand and treat patients. I felt no great lack in not having a diagnostic manual for this purpose.
So I approached the PDM with considerable skepticism (and, I might add, trepidation, given its size). I am pleased to say that I found myself very pleasantly surprised by the PDM on the whole, with some caveats.
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