DSM-V – Somewhat arbitrary?

Earlier in the semester, I posted about the story of the creation of the DSM-IV classification system based on psychological characteristics.   Today’s New York Times addresses the latest release, the DSM-V.  It’s an ideal case study for classification themes we’ve reviewed all semester:

“In psychiatry no one knows the causes of anything, so classification can be driven by all sorts of factors” — political, social and financial.”

“What you have in the end,” Mr. Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”

http://www.nytimes.com/2008/12/18/health/18psych.html?hp

N grows over time..

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On the Subject of Important Definitions – OR – Why Politics and Categorization Don’t Mix

In Erin Knight’s post, she talks about how the Capitol is trying to figure out how to redefine homelessness. This reminds me of a similar issue that I have encountered year after year while working for Contra Costa County.

Back in about 1970, a bit of research was done to determine what the poverty level should be. They did a bunch of research, but eventually just decided that the thing to do was to simply take the cost of food for a given family size and then multiply it times three. Out of this math, we have the poverty level.

From this number, the government has adjusted every year for inflation, and with that, we arrive at the federal poverty levels for 2008.

Now, this would be pretty bad research, and were I the professor overseeing the high schoolers responsible for these measures, I would probably scold them for committing every bad research method ever. The federal government however has taken these measures, and based pretty much every aid program on them….for the past 30-40 years.

Brilliant.

In class, we have talked about how important it is to have specific and precise ways of categorizing things. Unfortunately, this thing happens to be humans, and unfortunately nobody wants to raise the poverty level while in office because that will mean that X number of people fell into poverty during their time.

When politics meets categorization, problems ensue.

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Capitol Strives to Define “Homeless”

http://www.nytimes.com/2008/09/16/washington/16homeless.html?ref=us

NYTimes, 15 September, 2008

So the heated discussion of choice a few days ago in our nation’s capital was apparently how to define ‘homeless‘. For the last 20+ years, ‘homeless‘ meant “only people living on the streets or in shelters”. But given the high-and-getting-higher foreclosure and unemployment rates, the Hill is arguing whether or not to expand that definition.

New expansions of the existing definition under consideration are:

1) to include the ‘precariously housed’ (living with friends, couch-to-couch, day-to-day hotels, etc)

2) just to include the smaller number of people who have fled due to domestic violence

3) to include “only those forced to move three times in one year or twice in 21 days”

(Obviously we have some variance in specificity here.)

The definition is important because whoever qualifies as ‘homeless‘ is eligible for aid, shelter and housing assistance from the Department of Housing and Urban Development.

That said, in a typical DC move, none of the bills have anything about increasing funding.  The current budget ($1.7MM) can’t come close to providing enough/adequate resources for the people falling under the current definition of ‘homeless‘.  So while expanding the definition seemingly demonstrates homeland concern and goodwill, instead of a semantic debate, they should be talking about actions/solutions to actually care for these people.

(And of course it is turning into a Democrat/Republican flame war.  I would paraphrase but you know the drill…)

Two additional thoughts:

  • I think I may have lived couch to couch at some point in my younger younger years.  That definition might need some fine tuning to avoid dealing in every 22 year old in the country.
  • I don’t miss DC at all.

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