Why is the diagnostic and statistical manual of mental disorders so hard to revise?:path-dependence and “lock-in” in classification

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the D.S.M.-5, was published in May 2013. In the lead up to publication, radical changes to the classification were anticipated; there was widespread dissatisfaction with the previous edition and it was accepted that a “paradigm shift” was required. In the end, however, and despite huge efforts at revision, the published D.S.M.-5 differs very little from its predecessor. This paper considers why it is that revising the D.S.M. has become so difficult. The D.S.M. is such an important classification that this question is worth asking in its own right. The case of the D.S.M. can also serve as a study for considering stasis in classification more broadly; why and how can classifications become resistant to change? I suggest that classifications like the D.S.M. can be thought of as forming part of the infrastructure of science, and have much in common with material infrastructure. In particular, as with material technologies, it is possible for “path dependent” development to cause a sub-optimal classification to become “locked in” and hard to replace

What does hoarding tell us about mental health?

Rachel Cooper on classifying mental disorders and the DSM

Psychiatric classification and subjective experience

This article does not directly consider the feelings and emotions that occur in mental illness. Rather, it concerns a higher level methodological question: To what extent is an analysis of feelings and felt emotions of importance for psychiatric classification? Some claim that producing a phenomenologically informed descriptive psychopathology is a prerequisite for serious taxonomic endeavor. Others think that classifications of mental disorders may ignore subjective experience. A middle view holds that classification should at least map the contours of the phenomenology of mental illness. This article examines these options. I conclude that it is not true that phenomenology is a logical prerequisite for classification, nor even that classification should necessarily respect phenomenological boundaries, but that detailed phenomenological examination can sometimes inform classification

First do no harm?:what role should considerations of potential harm play in revising the D.S.M.?

Guidelines for revisions to D.S.M.-5 asked those proposing changes to consider potential harms to patients. This has been controversial. This paper argues that seeking to do no harm is appropriate when constructing a scientific classification scheme. I show that in many cases considerations of harm avoidance can play a role in influencing the design of the D.S.M. without the pursuit of scientific knowledge being compromised. I then turn to cases where compromise is required. Through a consideration of cases where lying is required to save lives I suggest that it is widely accepted that harm-avoidance can trump truth-telling. In extreme circumstances a psychiatric classification might thus set out to mislead in order to prevent harm

Social and Behaviour Change Communication Interventions in Mozambique

Social and behaviour change communication (SBCC) is the use of communication to change behaviours by positively influencing knowledge, attitudes and social norms at the individual and community level. Approaches to SBCC include, but are not limited to: media campaigns, peer educators and mentors, small group sessions, community dialogues and events, and digital tools. This rapid literature review focuses on SBCC interventions in Mozambique across four sectors: family planning (FP); girls’ empowerment; water, sanitation and hygiene (WASH), and nutrition. The most common SBCC approaches across the four sectors include: Inter-personal communication, Community participatory approaches, SMS based platforms, and Media channels. This review draws on evaluations of SBCC intervention, donor reports, and qualitative evidence collected by implementers and funders. There is a relatively large evidence base for FP and nutrition interventions, and a comparatively smaller one for WASH and girls’ empowerment. No lessons learned from integrating WASH and nutrition programming could be found during the course of this review. Although there are examples of nutrition programming including WASH in their counselling interventions, as well as calls for the development of multisectoral programmes. For example, in 2017, UNICEF signed a multi-sectoral proposal covering WASH, nutrition, and behaviour change funded by the EU. The programme will work in Nampula and Zambezia Provinces between 2017 and 2021

Water Management/Governance Systems in Pakistan

This review largely focuses on government/formal water management and governance systems in Khyber Pakhtunkhwa and Punjab provinces and outlines a number of key challenges that are common across the two provinces. Challenges can be grouped into three categories, i.e. challenges at the management and governance level, challenges related to financial stability and lack of investment and challenges related to mega-trends. This review draws on recommendation for improving formal water management and governance which includes improving monitoring and evaluation, capacity building, installing water meters, proper waste and wastewater management and regulation including building treatment plants, and raising awareness of water conservation (SBP, 2017; IUCN, 2014, p. 33). It also identifies that gender is extremely important in terms of both access to water and sanitation and participation in decision-making processes and governance (see for example, Nadeem et al., 2013)

Natural Resources Management Strategies in the Sahel

This helpdesk review has drawn primarily on evidence from systematic reviews and synthesis studies focused on natural resources management strategies in Sahel (Burkina Faso, Chad, Mali, Mauritania and Niger). It identifies effective strategies to improve renewable natural resources management have focused on land rehabilitation and water management. Projects such as the World Food Programme Cash for Assets in Niger have increased the number of hectares under cultivation in targeted areas. Successful strategies involve local communities and need to be scaled-up to the national or regional level. However, key challenges to be taken into consideration in managing renewable natural resources are: increasing conflict between pastoralists and farmers, poor soils and soil erosions, land-use and land-cover changes, the inter-connected nature of environmental issues and climate change. In addition to this, extractive resources, including uranium in Niger and oil in Chad, are extremely important export commodities for the countries of the Sahel. However, NGOs, civil society and donors are concerned about the transparency and governance of extractive industries as well as the generation and use of revenues (Larsen & Mamosso, 2014). Practitioners, donors and academics have suggested a number of strategies or interventions to improve the effectiveness of extractive resources management. These include improving the flow of information about extractives; greater disclosure of information and compliance with the Extractive Industries Transparency Initiative; and, building the capacity of government staff to monitor compliance with regulations (IMF, 2016; Larsen & Mamosso, 2014). The World Bank and IMF are key actors working to improve governance of the extractives sector

Legal Pathways’ Effects on Irregular Migration

This report synthesises evidence on the effects of the availability of legal pathways on irregular migration. Regular migration pathways include labour mobility regimes, sponsorship programmes for high skilled workers, student visas and protection for refugees. In contrast, irregular migration pathways include illegal entry, overstaying a visa and befallen irregularity (where regular status is lost). The links between regular (legal) pathways for migration and irregular migration are complex, however, two linked assumptions are common in the evidence base for this report. The first assumption is that destination states’ restrictive migration policies and the lack of regular pathways pushes migrants into irregular entry, illegal residence and befallen irregularity. The second assumption is that expanding regular migration will reduce irregular migration as people would chose to migrate regularly if options were available. Options for expanding regular pathways include labour mobility regimes, safe pathways for refugees and expanding visa options for students and low-skilled workers. However, it is also possible that expanding regular pathways could result in increases in irregular migration and smuggling along specific corridors

Maternal, Newborn and Child Health in Emergency Settings

More than 500 women and girls die in emergency settings every day due to complications arising from pregnancy and childbirth (UNFPA, 2018, p. 3). In 2017, an estimated 535 million children (nearly one in four of the world’s children) lived in countries affected by emergencies (UNICEF, 2017). This report provides examples of organisations working in maternal, newborn and child health (MNCH) in emergency settings and some key technical resources