You know, looking back, I can see I had been feeling this way about you for the past year or two. Oh, sure, when we first met, back in grad school, I was all seduced (the way only a clinical psychologist can be!) by your mystery, your back story, so curious was I to learn all about you and where you had been all my young professional life. I learned about your history, and how you had grown through so many phases in your own life. I looked past the way you came into my life from a new culture, in a language I was not sure I wanted to speak.
But I was so inept, fumbling clumsily as I tried to learn your language, your culture, even though I was also learning it was completely counter to the way I was becoming acculturated to see the people and the world. How much easier it must have been for all who grew up with your forebears in the 60’s, 70’s and 80’s. By the time we met in the early 90’s, as the DSM-IV, you had grown and changed so much you hardly resembled those from your family of origin. I know we were severely tested in 2000, but in time I was able to adapt, adjust to your changes. You weren’t that different. In time we settled back into one another.
But that changed in 2013 with the publication of the DSM-5. I have not healed from this rupture. As the DSM-5 was published, larger than ever, organized in a way that I could not understand, reflecting several years of work groups and politics, a neurodevelopmental focus and the influence, of pharmaceuticals and what has become of modern psychiatry, I felt like I needed to make a clean break. I no longer knew who you were. This time away for me has been healthy. It has also made me feel as if I am ready to move on and into a new relationship. This time with the ICD-10. The more I learn about the ICD-10, the more I feel like I am in a relationship with a whole self-system with all the constituent parts. It feels complete. Not like the DSM-5, to whom I had a relationship with only one part that did not grow with me, and which I began to resent.
So welcome, ICD-10. I welcome you into my life. (Yes, I know you will soon become an ICD-11). Again, I am taken with your mystery and the complexity, but also the parsimony and utility. It feels so much healthier. The ICD-10, which is a classification system used in nearly every part of the world (not like the DSM, that is mainly used in the U.S. and parts of Europe) is useful mainly for insurance reimbursement purposes (it’s the language the insurance companies speak). It is now replacing the DSM system in my life. We all will need to get acquainted.
I can still turn to the DSM, just like an old relationship: mindful of its limitations, aware of my own expectations, trusting in my own new found confidence in myself as a psychologist as often only a relationship breakup can teach. I am now aware of my need to seek balance and moderation and to say goodbye to what is now becoming a transitional object, the DSM.
Oh, I can still check in: the DSM can still help me organize (should I desire it) information, signs and symptoms to arrive at a diagnosis. But I no longer am required to put a DSM code on insurance claims and health information. As of October 1, 2015, I will be required to use the ICD-10. I can wholly own this new and growing part of a healthy professional identity with psychiatry no longer playing a role in our relationship. Goodbye, DSM. It is so liberating …
Now if I can just get off those darn insurance panels!