PBS高端访谈:DSM-5对诊断精神病患意味着什么

 　　JUDY WOODRUFF:Next: changes to the so-called “bible” of psychiatry¹ and what it means for diagnosis² and treatment.

　　This weekend, the American Psychiatric Association released a revision to the Diagnostic and Statistical³ Manual of Mental Disorders⁵, often referred to as “the DSM.” It's the first comprehensive update since 1994.

　　Doctors often utilize⁶ the DSM to diagnose mental illnesses. And there's been much debate over the years about its role. We look at the changes to this manual now with two experts.

　　Dr. Michael First, he's a psychiatrist⁷ at New York Presbyterian Hospital and a professor at Columbia University. And Dr. Steven Hyman, former director of the National Institute of Mental Health at NIH. He's the director of the Stanley Center for Psychiatric Research at the Broad Institute.

　　Gentlemen, we welcome you both.

　　Dr. First, let me turn to you. Why is this updated diagnostic manual so important?

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　　DR. MICHAEL FIRST, Columbia University: Well, the reason it's so important is, the DSM is the guidebook that is used by all mental health professionals. It's crucial to their ability to practice.

　　It defines all of the psychiatric diagnoses. And the psychiatric diagnosis, arriving at a correct psychiatric diagnosis is the first step in trying to pick the best treatment for patients. So, it is something that has enormous influence on everybody's ability to provide the best treatment that's possible.

　　JUDY WOODRUFF:Dr. Hyman, you have a somewhat different take on the value of it.

　　DR. STEVEN HYMAN, Broad Institute: Well, I think it's critically important, as Dr. First said, for diagnosis and for insurance reimbursement⁸.

　　But I think that the DSM is scientifically early. The brain gives up its secrets grudgingly⁹. And we have to understand the DSM as a set of guidelines to diagnosis of often very serious disorders, but not as the bible of psychiatry. It is hardly meant to be by either the people who wrote it or in reality a perfect mirror of nature.

　　JUDY WOODRUFF:If it's an imperfect thing, Dr. First, how does that affect what doctors can do and how patients are helped or not helped?

　　MICHAEL FIRST:Well, it's imperfect mainly because our understanding of the core of how mental disorders, what's behind mental disorders, remains¹⁰—there's a lot more to be understood.

　　And certainly, as we understand more over the years, our ability to provide the ultimately best treatment will continue to be improved. But what the book does now, it's really a culmination¹¹ of what we know about mental disorders. And that's very, very helpful in being able to pick the right treatment.

　　So I agree with Dr. Hyman. It's certainly not a bible. I think a better way to look at the DSM, it's like a dictionary. It allows people to communicate. It allows mental health professionals to communicate with one another. It allows them to communicate with their patients. It allows us to communicate with administrators¹², so that we're all talking about the same conditions.

　　It has its limits because our knowledge of the way mental disorders work has their limits.

　　JUDY WOODRUFF:Dr. Hyman, so how are patients affected¹³ by the changes in this new version of the manual?

　　STEVEN HYMAN:Well, I think the most important thing are patients. I mean, after all, diseases like schizophrenia, bipolar disorder⁴, autism, depression, OCD—and I could go on—are the most disabling disorders in aggregate¹⁴ in the United States and cause enormous suffering.

　　It's critical that doctors and in fact all mental health professionals have ways of matching patients with treatments, and also that the whole administrative¹⁵ apparatus¹⁶ around medicine has a way of reimbursing¹⁷ those things.

　　What the DSM does is to provide a shared language so that mental health professionals and patients and insurance companies know they're talking about the same thing. And I think that is all well and good, as long as we don't assume that every semicolon in the document is somehow rigidly¹⁸ guiding us.

　　And so, in the end, I hope that with this new revision and with—despite the controversies¹⁹, that well-trained mental health professionals will still make sure that all patients in need of services get services. And I don't really see anything in the revisions that should get in the way of that.

　　JUDY WOODRUFF:Well, that's a question.

　　Dr. First, if—I mean, how much danger is there? Because there are some changes in here. For example, Asperger's is I guess no longer in a separate category. It's put under the heading of autism. But that's just one of a number of modifications²⁰ that were made. How do you see patients being affected by this?

　　MICHAEL FIRST:Well, the belief is, is that since the manual reflects the current science—and science continues to move along, perhaps slower than a lot of people would like it to, but there is still a continuing improvement in our description of mental disorders and our being able to—ability to be able to predict their course.

　　So the DSM will provide patients, as well as their clinicians, with the most up-to-date information to be able to provide help. Again, it's far from perfect, but it's still extremely useful. And it's the best we have. And I think we have a lot to offer our patients, and the DSM is really the most up-to-date tool to provide that help to our patients.

　　JUDY WOODRUFF:But I heard Dr. Hyman say that if—if professionals interpret it too rigidly, that could be harmful.

　　MICHAEL FIRST:That's true.

　　One of the rules on the front of the DSM that has been there actually since the beginning is—it says it very, very clearly. It's not to be used as a cookbook. Clinical judgment²¹—people go and learn how to be mental health professionals and spend years in practice gaining a skill. And that skill is the ability to use their clinical judgment in making decisions.

　　And that clinical judgment remains crucial. The DSM is part of the decision-making process for making a psychiatric diagnosis. And Dr. Hyman is actually—absolutely right. If somebody were to open up the book and just read the words and just apply them without using any clinical judgment, that could be very, very harmful. But that's completely at odds²² with the way the book is supposed to be used.

　　And it says so in front of the book in plain language: This is not a cookbook. This must be used with clinical judgment.

　　JUDY WOODRUFF:Dr. Hyman, what about the use that insurance companies and others make, educational institutions make of this and how doctors use it?

　　STEVEN HYMAN:Well, I often say that doctors use the book, but just in the way that Dr. First said, with clinical judgment.

　　People who are insurance claims adjustors and educators and people in courts of law are not trained as clinicians and tend to read the book quite literally²³. And I think—I think it's important that, with the revision, there be appropriate educational efforts again to make sure that nobody who really is in need of services is denied services or the book is taken to be too literal.

　　I think, given our current state of knowledge, there have to be compromises. And the book provides a way of communicating between clinicians and patients and people like insurance claims examiners. That said, I think the greatest problem with the book—and I think Dr. First and I agree with this—the people who should take it least literally are scientists, because you can get yourself into the fix that if you recognize that the book is imperfect, but you force yourself to follow every dictate²⁴ quite literally, then you find yourself unable to make the very necessary progress that psychiatry needs.

　　Again, the brain is the most complicated organ in the history of human scientific endeavor. And we need to be able to approach it with an open mind.

　　JUDY WOODRUFF:Well, it is—it does offer some big changes. And we help—we thank you both for helping²⁵ us at least understand a part of how it all works.

　　Dr. Michael First, Dr. Steven Hyman, we thank you both.

　　STEVEN HYMAN:A pleasure.

　　MICHAEL FIRST:Thank you.

1 psychiatry   

n.精神病学，精神病疗法

参考例句：

• The study appeared in the Amercian science Journal of Psychiatry.这个研究发表在美国精神病学的杂志上。
• A physician is someone who specializes in psychiatry.精神病专家是专门从事精神病治疗的人。

2 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

3 statistical   

adj.统计的，统计学的

参考例句：

• He showed the price fluctuations in a statistical table.他用统计表显示价格的波动。
• They're making detailed statistical analysis.他们正在做具体的统计分析。

4 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

5 disorders   

n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调

参考例句：

• Reports of anorexia and other eating disorders are on the increase. 据报告，厌食症和其他饮食方面的功能紊乱发生率正在不断增长。 来自《简明英汉词典》
• The announcement led to violent civil disorders. 这项宣布引起剧烈的骚乱。 来自《简明英汉词典》

6 utilize   

vt.使用，利用

参考例句：

• The cook will utilize the leftover ham bone to make soup.厨师要用吃剩的猪腿骨做汤。
• You must utilize all available resources.你必须利用一切可以得到的资源。

7 psychiatrist   

n.精神病专家；精神病医师

参考例句：

• He went to a psychiatrist about his compulsive gambling.他去看精神科医生治疗不能自拔的赌瘾。
• The psychiatrist corrected him gently.精神病医师彬彬有礼地纠正他。

8 reimbursement   

n.偿还，退还

参考例句：

• He received reimbursement for his travel expenses.由于出差的花费他可以得到公司的补偿。
• Which forms do I need to complete for my travel reimbursement?我需要填什么表来报我的旅费？

9 grudgingly   

参考例句：

• He grudgingly acknowledged having made a mistake. 他勉强承认他做错了。 来自《简明英汉词典》
• Their parents unwillingly [grudgingly] consented to the marriage. 他们的父母无可奈何地应允了这门亲事。 来自《现代汉英综合大词典》

10 remains   

n.剩余物，残留物；遗体，遗迹

参考例句：

• He ate the remains of food hungrily.他狼吞虎咽地吃剩余的食物。
• The remains of the meal were fed to the dog.残羹剩饭喂狗了。

11 culmination   

n.顶点；最高潮

参考例句：

• The space race reached its culmination in the first moon walk.太空竞争以第一次在月球行走而达到顶峰。
• It may truly be regarded as the culmination of classical Greek geometry.这确实可以看成是古典希腊几何的登峰造级之作。

12 administrators   

n.管理者( administrator的名词复数 )；有管理（或行政）才能的人；（由遗嘱检验法庭指定的）遗产管理人；奉派暂管主教教区的牧师

参考例句：

• He had administrators under him but took the crucial decisions himself. 他手下有管理人员，但重要的决策仍由他自己来做。 来自辞典例句
• Administrators have their own methods of social intercourse. 办行政的人有他们的社交方式。 来自汉英文学 - 围城

13 affected   

adj.不自然的，假装的

参考例句：

• She showed an affected interest in our subject.她假装对我们的课题感到兴趣。
• His manners are affected.他的态度不自然。

14 aggregate   

adj.总计的，集合的；n.总数；v.合计；集合

参考例句：

• The football team had a low goal aggregate last season.这支足球队上个赛季的进球总数很少。
• The money collected will aggregate a thousand dollars.进帐总额将达一千美元。

15 administrative   

adj.行政的，管理的

参考例句：

• The administrative burden must be lifted from local government.必须解除地方政府的行政负担。
• He regarded all these administrative details as beneath his notice.他认为行政管理上的这些琐事都不值一顾。

16 apparatus   

n.装置，器械；器具，设备

参考例句：

• The school's audio apparatus includes films and records.学校的视听设备包括放映机和录音机。
• They had a very refined apparatus.他们有一套非常精良的设备。

17 reimbursing   

v.偿还，付还( reimburse的现在分词 )

参考例句：

• All banking charges outside Korea and reimbursing are for account of beneficiary. 所有韩国以外的用度及偿付行用度由受益人承担。 来自互联网
• A reimbursing bank's charges are for the account of the issuing bank. 然而，如果费用系由受益人承担，则开证行有责任在信用证和偿付授权书中予以注明。 来自互联网

18 rigidly   

adv.刻板地，僵化地

参考例句：

• Life today is rigidly compartmentalized into work and leisure. 当今的生活被严格划分为工作和休闲两部分。
• The curriculum is rigidly prescribed from an early age. 自儿童时起即已开始有严格的课程设置。

19 controversies   

争论

参考例句：

• We offer no comment on these controversies here. 对于这些争议，我们在这里不作任何评论。 来自英汉非文学 - 历史
• The controversies surrounding population growth are unlikely to subside soon. 围绕着人口增长问题的争论看来不会很快平息。 来自辞典例句

20 modifications   

n.缓和( modification的名词复数 )；限制；更改；改变

参考例句：

• The engine was pulled apart for modifications and then reassembled. 发动机被拆开改型，然后再组装起来。 来自《简明英汉词典》
• The original plan had undergone fairly extensive modifications. 原计划已经作了相当大的修改。 来自《简明英汉词典》

21 judgment   

n.审判；判断力，识别力，看法，意见

参考例句：

• The chairman flatters himself on his judgment of people.主席自认为他审视人比别人高明。
• He's a man of excellent judgment.他眼力过人。

22 odds   

n.让步，机率，可能性，比率；胜败优劣之别

参考例句：

• The odds are 5 to 1 that she will win.她获胜的机会是五比一。
• Do you know the odds of winning the lottery once?你知道赢得一次彩票的几率多大吗？

23 literally   

adv.照字面意义，逐字地；确实

参考例句：

• He translated the passage literally.他逐字逐句地翻译这段文字。
• Sometimes she would not sit down till she was literally faint.有时候，她不走到真正要昏厥了，决不肯坐下来。

24 dictate   

v.口授；(使)听写；指令，指示，命令

参考例句：

• It took him a long time to dictate this letter.口述这封信花了他很长时间。
• What right have you to dictate to others?你有什么资格向别人发号施令？

25 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。