Talk:Diagnostic and Statistical Manual of Mental Disorders

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[edit] Old comments that lacked a header

It is a terrible shame to waste much energy whining about disclaimers. I would prefer a more critical approach consisting of the implications of using such a diagnostic i.e the overlap between disorders. Also links to relevent advocates and challegeners of the DSM would be ideal.

I made some changes, what do you think? I would like make more. What speically would people like? Some of the article appears to be POV, I tried to make it more objectiveExpo512 08:43, 6 March 2006 (UTC)

Isn't it like IVr or some upgrade of the original IV?

I think something needs to be said about the changes between III-R and IV, like the introduction of five different axes to differentiate mental, social and physical functioning. That whole system could be put in the introduction, since it's the current standard. -- Kimiko 19:03, 17 Mar 2004 (UTC)

I have added a link to a list of DSM Codes to the See Also section of this page. I'm new here, so I hope that I have remained within the proper codes of conduct or etiquette. Cool? Erikpatt 06:15, 11 Jan 2005 (UTC)

I have added some criticism of DSM IV, this may be a personal opinion but I think it's justified. See what you think.

[edit] Confusing, blathering article

Needs:

  1. clear statement of what the DSM is
  2. some discussion (pref. in layman's terms) of how professionals use it
  3. section of criticism

Currently, a critique is buried in the "brief history" section. Here's some more criticism:

The use of the DSM, as Herb Kutchins and Stuart Kirk have said, reflects ‘a growing tendency in our society to medicalize problems that are not medical, to find pathology where there is only pathos, and to pretend to understand phenomena by merely giving them a label and a code number.’ [1]

Others have criticized DSM for permitting pressure groups to put in or take out things - instead of disorders being added strictly on the basis of scientific evidence. The exclusion of homosexuality was heralded by gay rights groups as proof that homosexuality is normal - yet it was only their political pressure on the APA that made it remove homosexuality. Uncle Ed 17:27, 9 November 2005 (UTC)

Added statement about how professional use it, by request aboveExpo512 (talk) 05:37, 30 November 2007 (UTC)

[edit] Only Copies APA Information

The article only copies the description from the APA. That is fine for a beginning. But the point that the described disorders do not exist is not fully developed. Although there is mention that the DSM is based on the opinion of "Experts" it should be mentioned that this is done by voting not scientific methods.

There is no scientific basis for the DSM. The disorders are based on observations and attempted groupings of similar appearing behaviors. The titles of disorders change over time.

The problem is that there is no provable causation to allow a correct organization. Typical is the diagnosis of PTSD. PTSD is thought to be caused by trauma but now it is diagnosed when the trauma was in the remote past. There is no evidence that the subject of flashbacks or panic attacks observed in PTSD are the cause of those incidents.

This thinking is little more than the primitive beliefs involved in the Culture Bound Syndrome of Susto. There, even physical illness is thought to be caused by startle or fright even if that event happened to a parent rather than the effected person.

L K Tucker 22:28, 4 December 2005 (UTC)

Those points are argued further on these two pages.


http://visionandpsychosis.net/Culture_Bound_Syndromes.htm

http://visionandpsychosis.net/PTSD.htm

[edit] DSM-IV-TR Permissions Controversy

[This discussion might be interesting to anybody interested in,or knowledgable about, DSM-IV-TR:

http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/Incidents#DSM-IV-TR_Copyright_question --82.195.137.125 19:13, 20 December 2005 (UTC)]

Link Update: http://en.wikipedia.org/wiki/Wikipedia:Administrators%27_noticeboard/IncidentArchive57#DSM-IV-TR_Copyright_question


is the diagnostic and scinetific manual a science or pseudo science?

[edit] Homosexuality

Wasn't the reason homosexuality was taken out of the DSM guide because of lobbying from gay rights activists? I ask because of the article's inference that homosexuality originally being in the DSM guide was a fault of the book. --Yodamace1 16:55, 5 January 2006 (UTC)

The objectivity of the article is totally removed with the phrase "those homo fags". This should really be fixed, but I don't feel qualified to just change it to "homosexuals" or something else. --A Visitor 07:20, 8 January 2008 (UTC) —Preceding unsigned comment added by 64.91.106.159 (talk)

The recent section about the Drs. Zucker, Blanchard and Lawrence being selected for the American Psychiatric Assoc.'s committees should have been corrected rather than entirely removed for reported reason that it is factually incorrect as to Lawrence. Whether Zucker and Blanchard promote so-called reparative therapy on children (they deny they do) it needs to be reported that an overwhelming majority of the Queer community (rightly or wrongly) is protesting their appointment largely on that basis. Oddly, the Queer community and NARTH are in agreement that Zucker and Blanchard are in favor of ex-gay reparative therapy for children (despite Z+B's claims not to be) partly because their actions contradict their words. —Preceding unsigned comment added by 69.226.225.201 (talk) 20:06, 18 May 2008 (UTC)

[edit] Discrimination and future of DSM

lwtyyyyyyyyyyyyyyyyyyyyyyyyyttttttttarticle? -Amit

Are you serious?! And to think that homosexuality itself was considered a "mental illness" until 1973. Such a move would show to the wider world that the DSM has no basis in objective scientific reality at all, but is just pseudoscience which slavishly follows social trends. I for one find it quite chilling that a person could be classified as mentally "ill" simply because of their political views or sexual tastes. You could envisage that sort of thing happening in the former Soviet Union, or in the "People's" Republic of China. 217.155.20.163 00:10, 15 October 2006 (UTC)

We must try to keep in mind that most of the concepts presented in the DSM can be viewed on a continuum and that almost all diagnoses require that there be significant impairment in work, social, or leisure activity that can be documented before the diagnosis is presented. Also, for most diagnosis there is a prevalence rate in which it can help us determine how rare the particular disorder should be within given samples. I do not have the research but if there was an addition of that calibar then it would be based on a rare impairing form of what is being referred to as 'bigotry'. Also, psychological testing uses the idea of clinical as opposed to statistical significance. Clinical significance can be usually seen in which those only scoring 2.5+ standard deviations are usually considered ill which is less than 10% of the population that it was standardized with. That is usually viewed rare enough to warrant further investigation. For this above example, the ideation of bigotry can be very over-simplified and become a belief in trend then what could conceivably be a detremental thought 'disorder' since I lack a better word at this moment. I will try to stress that clinicians use multiple resources besides just the DSM in order to make a diagnostic decision including lab and physician findings and psychological scores etc. UNache 23:26, 5 February 2007 (UTC)

No: Creating a specific diagnosis for extreme racism doesn't seem to be in contemplation.[2] The usual reasons for not including it are:
  • Other, existing categories are typically sufficient (paranoia, delusions, obsessions) and often much more descriptive of the whole situation. (It's likely that more mental health professionals need to recognize racism as a presenting symptom of these other conditions, but that doesn't make racism itself be the disease.)
  • Race is a culturally constructed identity, and racism can be a societal norm. Until the entire world (remember that this book gets used worldwide) is dramatically less racist than it is now, racism by itself can legitimately be considered a variation on culturally normative behavior. You can really only call racism a "disease" (a personality disorder?) if the client's society is normatively non-racist.
  • There don't seem to be any published cases of people who are pathologically racist (under the usual clinical standards: your ideations significantly interfere with your own everyday life) unless they also have other, significant mental disturbances. For example, I met a man last year whose severe paranoid schizophrenia prompted him to make an enormous number of anti-gay and anti-Jew remarks (averaging every fourth sentence, no matter the subject matter). However, in the context of the whole picture of his life, his racism was really a small symptom.
This is an issue that highlights the complexity of the DSM's broad subject matter. Some psychological problems are socially constructed instead of biologically determined. Some psychological "problems" are also perfectly normal (e.g., transient situational depression). The DSM covers all of the above. WhatamIdoing 03:57, 10 July 2007 (UTC)

[edit] Cautionary statement

Can anyone explain the purpose of the "cautionary statement" section? The first sentence sort of makes it sound like it is about a "DSM cautionary statement" that is part of the DSM, or is something related to it, but as I read the section it sounds more like the caution is being advised by an author of the article itself. If this is the case, something needs to be done -- no matter how well-intentioned a warning to the reader may be, it is not NPOV to say, "You should know that X is a bad idea" instead of providing facts. (It kind of runs afoul of the "avoid self-references" guideline as well.) This is why Wikipedia has a medical disclaimer. It would certainly be appropriate to have some text in the article describing how and why the DSM is not intended to be used by amateurs, but an entire section that positions itself as a caution from the article to the reader needs to be rewritten so that it only describes the subject from a neutral stance.

If anyone else understands whether the "DSM cautionary statement" is supposed to describe some external statement in the world, or whether it is meant to itself be a caution to the reader, please edit the article as needed. Thank you. –Sommers (Talk) 17:29, 24 January 2006 (UTC)

I've rewritten the section so that it only provides information, not advice, as described above. I think it's much more concise and neutral this way, and the section still gets it across quite clearly that the DSM isn't meant to be used by amateurs, so I don't anticipate any problems with the new draft. If anyone can replace the "Experts generally advise..." with a real citation, though, that would be great. If anyone has any objections to the changes I made, I'm more than willing to discuss them. Thanks. –Sommers (Talk) 01:57, 25 January 2006 (UTC)
The original version [3] was fairly neutral. It reminds me somewhat of the standard disclaimer before introductory abnormal psychology classes (The kind they claim they shouldn't be teaching because the information could be mis-used, but which they teach anyway). Probably more than a generic DSM disclaimer, there should be a statement that diagnoses should be left to experts.--Limegreen 21:28, 6 March 2006 (UTC)
I agree. However, I feel I should clarify: the point I was trying to make above (and below) is that the statement you mention should be one of fact and not of advice. Any competent encyclopedia article on the DSM should provide facts indicating that the diagnoses should be left to experts, without having to actually come out and state it to the reader. –Sommers (Talk) 04:22, 23 March 2006 (UTC)

[edit] Outdated links to cautionary statement

Upon further examination of which pages link to what used to be the dedicated "DSM cautionary statement" page, it appears that a lot of psychology-related articles were formerly referring to a page which contained a much larger and widespread description of problems perceived with the DSM. This is a problem, since most of those links now refer to a statement that has not properly existed since it was merged into this article. (A lot of it was moved into the "Development" section even before I did the most recent revision of what remained of the "cautionary statement" section.)

I think the best thing to do would be to remove (or at least rewrite) all direct references in other articles to the former cautionary statement. It was an explicitly POV (although well-intentioned) piece that, by its own title, existed only to make a statement about the weaknesses of the DSM (presumably to warn the reader against trusting it too much). It would be much better to describe these possible weaknesses, carefully in line with the NPOV policy, in a section of this article ("Criticisms" or something similar; it seems weird to have this under "Development" anyway) like we would with any controversial subject, and the other articles can point to the relevant issues with the DSM if and when they apply instead of to a blanket statement.

However, because the use of this "cautionary statement" page and the links to it predate my involvement, I'd like to get some feedback on all of this before I take it upon myself to start making changes across a lot of different articles. If no one objects, I'll get started on working my way down this list. Of course I shouldn't be the only one doing this: beside the fact that it's a big task, there are probably plenty of instances where an article says "(See the DSM cautionary statement)" where it really needs something more specific to be added, and I'll likely lack the necessary expertise in most of those cases. So if you want to make the edits yourself, please do. Otherwise, any feedback or information would be appreciated (including explanations about the former use of the cautionary page). Thanks.

–Sommers (Talk) 05:00, 25 January 2006 (UTC)

(I've taken the liberty of moving several posts from here to the bottom of the page, so that they will be in chronological order. If Zeraeph or anyone else objects, please feel free to revert. Thanks. –Sommers (Talk) 22:13, 27 March 2006 (UTC) )

[edit] Done

After having set this task aside for some time, I saw that there were no objections and proceeded. All mention of the former DSM cautionary statement has now been excised from the main namespace. The articles that formerly linked to the statement are no longer visible at the "What links here" link above, so in case anyone would like to review the changes, here is the list of the articles:

I hope this helps to improve the neutrality of Wikipedia's overall treatment of the DSM. Any remaining comments or questions about this matter are still, as always, welcome. Thanks again to Limegreen for the attention to my concerns. Happy editing! –Sommers (Talk) 04:10, 23 March 2006 (UTC)

While I agree that the cautionary statement presented a point of view and I understand the reasons for the merge (I merged them myself), I remain concerned that this particular point of view (a pov incorporated into and shared by the publishers of the DSM, the American Psychiatric Association) is rather significant. I perceive this particular information less as an opinion or editorial about the DSM and more like a "Mr. Yuk" for psychiatric diagnoses. I believe that sites such as this one, which draw individuals from outside of the mental health profession in search of clarification for diagnoses that they may have formally (or otherwise) received should have quick access to the pertinent and important information provided in a cuationary statement. So many of my clients are willing to blindly pursue treatment options that they believe are in accordance with a diagnosis that they may have arbitrarily received years and years ago. For this reason, I think a prominent sign saying "Stop and read this first!" that explains the limitations and purposes of diagnostic practices is important. I believe that it is the responsibility of the wiki community to acknowledge that the information available here is integrally linked with the treatment opportunities of those who access it. It seems that offering the reader easy access to a cautionary statement is part of this responsibility. I am a bit concerned that access to this information has been lost during the merge and revisions. There is a reason William Glasser refers to the DSM as "perhaps the most dangerous and harmful book ever created for mental health" and the cautionary statement is an industry accepted step toward recognizing the limitations and potential dangers of the DSM. It is naive to think that a layperson accessing basic encyclopedic information from this site will either acknowledge the limitations of this diagnostic toolbox or dig far enough as is currently necessary to access the warnings previously provided on the cautionary statement page. I was personally responsible for the merge as the community pointed out the limitations of the cautionary statement. However, I am concerned that the removal of this section from this entry removes the metaphoric Mr. Yuk and leaves readers less prepared to access objective information that may have significant impact on their lives. I hope that the wiki community can help with figuring out a way to prominently display this information in a wiki-appropriate format for readers. Erik 04:15, 22 March 2006 (UTC)

Thanks for your reply. First, I agree with everything you say about the DSM itself, and I'm glad you understand the POV problems with the original DSM cautionary statement. However, I believe what you are suggesting is also, for many of the same reasons, over the line with regard to NPOV. The central problem is that trying to caution the reader, even guide them toward or intentionally emphasize the relevant information with the metaphoric "Mr. Yuk" tag, is taking an instructional or persuasive stance; Wikipedia articles are allowed to do neither. Here are the details, as I see them. (Please forgive a very long post. This is a complicated matter and I wanted to make sure I didn't miss anything. Also, the suggestions you make are good ones, and the reasons that, in my opinion, we can't follow them are subtle but important.)

Wikipedia articles are supposed to be written so as to only provide information, from a neutral standpoint, with no authorial voice or stance. Trying to say "Stop and read this first!" is communicating something from author to reader, which is unacceptable. As I've said, the DSM article should carefully explain the book's limitations and describe the warnings experts have given against its improper use. However, it (and other pages) must not say to the reader "Hey, make sure you read this stuff about experts' warnings before you misuse the information". To do so would be unencylopedically POV, because—even if it isn't opinionated or editorial in tone—it's advancing the opinion that people need to be aware of a certain thing lest they make a harmful mistake. Much discussion has already taken place about giving special warnings to readers, and the decision has been not to do so (even without POV problems like this): as I said to Zeraeph above, please refer to Wikipedia:No disclaimer templates.

Also, I appreciate that the DSM cautionary statement page itself, as it currently exists, does neutrally provide facts much in the way I'm recommending, but it still needs to be removed. By taking these facts about the DSM's limitations and corralling them into a separate page (or even a separate section in the regular DSM article) in such a way as to warn the reader, we're creating a textbook example of a POV fork, which is a very bad thing, more so because the information has been explicitly put there to make a "statement". As I've said, the information itself given in the cautionary statement can and should be present in the regular DSM article, but must not be arranged in a cautionary or persuasive manner.

As for your concerns about laypersons not digging deep enough to see that information, I agree that this is probably a real problem, but I think it's a symptom of the article not presenting those facts properly. Because the point of view is, as you say, so widespread, the facts in question could be presented quite prominently in line with the NPOV policy without actually highlighting them to the reader with special links or tags. It's my opinion that, if the article were improved to a sufficiently readable and balanced condition, any rational and fairly intelligent person who reads the article would walk away with an understanding of how the DSM should and shouldn't be taken. (By analogy, someone who reads the article on firearms and had never heard of a gun before will walk away with the understanding that a gun could kill them, without a cautionary statement coming out and explicitly guiding them toward the gun safety article.) The other articles that link to the cautionary statement should take a similar approach, treating the DSM as one source of opinion without implying it's an incontrovertible reference book; I think they already do a fairly good job of this and they can be further improved if necessary. If the problem with the main DSM article is serious enough, perhaps it could be listed for review. Finally, because of the policies that the cautionary statement violates as I describe above, I think it behooves us to remove it right away, rather than leave it as a stopgap measure until the other articles receive such improvements.

Thanks for discussing this matter and for the understanding you've already displayed. (Thanks also for putting up with my long-windedness.) Any replies or questions would be very welcome. Unless there is a good reason not to, I'd like to get the cautionary statement and the links to it removed as soon as possible. Thanks again, and happy editing!

–Sommers (Talk) 17:08, 25 March 2006 (UTC)

For now, I have restored the last, brief, basic version of a "Cautionary Statement" that existed on this article as DSM cautionary statement. This seems to be some kind of legal requirement and, as a whole we are skating on such thin ice we are swimming, already with DSM and the APA, doesn't do to poke THAT particular tiger with too many sticks. I'm restoring the links as fast as I can. My only POV on this is FEAR OF THE APA ;o) --Zeraeph 13:17, 23 March 2006 (UTC)

Would you care to elaborate? I can see an argument for it being an ethical requirement, but under which countries laws is it a legal requirement? Also, wouldn't it be more appropriate to have a one sentence spoiler on each page. Perhaps if there is some consensus, a template could be created, similar to the plot spoiler warning{{spoiler}}:
Spoiler warning: Plot and/or ending details follow.
--Limegreen 23:07, 23 March 2006 (UTC)
There is no such legal requirement, and (while we should be as responsible as possible) the APA has no power to do anything to Wikipedia, unless they wanted to bring a groundless lawsuit. It is more or less the stated position of Wikipedia that its normal disclaimers (including the medical disclaimer, which applies here) are sufficient to be responsible to the readers and to protect Wikipedia from any liability, and it has already been decided at Wikipedia:No disclaimer templates that there is no need for additional warning messages like the DSM cautionary statement and what Limegreen suggests. If you think that the little "disclaimer" link at the bottom of every page isn't sufficient to warn readers, you probably aren't alone, but the thing to do is bring it up at the Village Pump, not create new protective measures on the fly. Thank you, however, for your concern and boldness regarding this matter.

Unless a consensus decision dictates otherwise, I believe that, under existing guidelines, your edits will need to be reverted soon. Please also see my remarks below (in response to Erik's post) about the unacceptability of the DSM cautionary statement in its current form. Any additional questions and discussion are most welcome. –Sommers (Talk) 17:08, 25 March 2006 (UTC)

The DSM contains it's own cautionary statement see [4]. HOWEVER the APA specifically refuses permission to use ANY content from the DSM IV TR including criteria. Strictly speaking all criteria should exist only as links to sites for which permission has been given.

All DSM criteria and transcriptions of same should be deleted. Now I am certainly not going to DO that deleting, but that is their position. When articles link to criteria on behavenet, the criteria already contain links the warning statement, as they are required to do. It's all a very dodgey area, but where the criteria still appear as part of an article it is simply wise to link the cautionary statement as would be required by the APA to avoid stirring them up. It would probably be best to just link their own disclaimer on behavenet.

And, I am afraid, if they take a mind to it, the APA most certainly CAN sue the bejaysus out of Wikipedia for copyright violation at any time, not least because permission fort use of criteria has been sought and refused...what on earth makes you think they can't? --Zeraeph 17:28, 25 March 2006 (UTC)

Wikipedia has the right to quote the DSM in line with our fair-use rights under copyright law. Sommers (Talk) 15:31, 27 March 2006 (UTC)
No it doesn't. "Fair use" isn't a right, it's a complex legal principle that must be proven through the courts to stand if someone wants to contest it. The APA contest that principle regarding wikipedia in specific (if you don't believe me, mail them for permission "Chad Thompson" <CThompson@psych.org> and explain about "fair use") and they have the lawyers and funding to back it up literally any time they feel like it, the trick is, trying to avoid them "feeling like it". This particular "storm in a teacup" is JUST the kind of thing to set them off at last.
Just for the record, while I personally feel the APA should concede "fair use" and that it would be to the advantage of all that they do so, sadly they do not agree. However, I cannot think of any counter argument to one of the arguments they put forward, which is that they cannot allow "fair use" for criteria where the text can be altered at any time. --Zeraeph 14:18, 28 March 2006 (UTC)


Reprinting entire sections of the DSM (or perhaps even individual criteria, word-for-word) would of course be copyright infringement, but if an article discusses a particular disorder and we want to give the fact, "The DSM lists X as a diagnostic criterion for this disorder", I don't believe the APA can legally prohibit us from doing so (because facts aren't copyrightable). Now, when Wikipedia articles do go beyond this point and infringe on the DSM, we should treat it like any other copyvio problem. (I agree that the problem does indeed exist for some articles.) But as you seem to be aware, there are two problems with using the cautionary statement to address the copyright matter: (1) Wikipedia hasn't been given the same permission as, for example, BehaveNet, so linking to a cautionary statement is a requirement that doesn't apply to us; and (2) as I've pointed out, Wikipedia's DSM cautionary statement is not the same thing as the DSM's own, so there is no point in linking to it anyway, except for a blind guess that it will somehow appease the APA.

If the purpose of the DSM cautionary statement is what you tell me, then what we're doing is bending the NPOV policy to meet an arbitrarily made-up standard in order to mimic a condition of a permission that we haven't been given. There's no legitimate reason to violate the NPOV policy and this isn't even a particularly good one. The cautionary statement is a POV fork, the links to it imply a critical opinion of the DSM, and they need to go now. That said, I understand your opinion and I'm glad you're paying attention to these matters. Thanks again for continuing to discuss this civilly. I look forward to your response. –Sommers (Talk) 15:31, 27 March 2006 (UTC)

I think you are getting a bit too far away from the point here, which is the PURPOSE of the DSM cautionary statement, which is, simply to explain what the DSM IS intended to be and what it is NOT, on behalf of the APA, to avoid misunderstanding or misuse. Like an "inflammable" or "dry clean only" label on a garment.
There are three ways to achieve that:
  • A Template
  • A link to a paraphrased article
  • A link to verbatum reproduction such as on behavenet
I would also very much like to see you qualify your statement that the existing article is POV by showing exactly which words and phrases you believe to be POV and why, because I honestly believe "POV" is a total misnomer for the point you are trying to make.
I am not saying that you shouldn't make your point, but if it is worth making at all it is worth making accurately.--Zeraeph 14:27, 28 March 2006 (UTC)
Please pardon the delay in my responding. As you know, I've addressed the "POV" thing at Talk:DSM cautionary statement. As for the top paragraph of your last post, I can respond to that with two of the points I've been trying to make all along. I apologize if these points weren't previously made too concisely or clearly, since this is (as I've said) a complicated matter and I can see how they may have gotten lost in the details. So, regarding the purpose of the statement:
  • The title of the DSM cautionary statement makes it brazenly clear that it is, in fact, a statement. Any such statement from the article to the reader can't be NPOV, because, no matter how impartial the statement itself may be, it reflects the point of view of the person or people who think readers ought to hear the statement. The central point here—which I think you also may be getting away from—is that it's just plain unencyclopedic to try to make a statement of any kind (let alone one with a cautionary purpose) in the main namespace, where we're only supposed to be providing information.
    • Sub-point: You say yourself that the cautionary statement is meant to be "on behalf of the APA". But "on behalf of the APA" is a point of view.
    • Also, to avoid misunderstanding, I do agree that we must "explain what the DSM IS intended to be and what it is NOT [...] to avoid misunderstanding or misuse", but we are bound by NPOV to do it in the article. Collecting facts from the article into a special statement off to the side is unencyclopedic.
  • The links that currently follow every citation of the DSM, which read "(See the DSM cautionary statement)", carry an implication something like: "The DSM says this, but you can't always take it at face value." If this were strictly a fact, then the links would indeed be as simple as a "dry clean only" label or the metaphoric "Mr. Yuk" advocated above. Unfortunately, it's not a fact; it's an opinion—an exceedingly widely-held and well-supported professional assessment, but an opinion nonetheless. The NPOV policy prohibits us from echoing that opinion, and taking special measures to urge readers to "see the DSM cautionary statement" comes far too close to doing exactly that.
I hope that does make my position a bit clearer. Thanks for your continued interest in hearing my points. –Sommers (Talk) 15:54, 30 March 2006 (UTC)

[edit] NPOV and vague words

Impotence, premature ejaculation, jet lag, caffeine addiction, and bruxism are examples of surprising inclusions

Who finds them surprising?

and are but only several that non-psychiatrists might not consider to be mental illnesses "non-psychiatrists"? And what do psychiatrists (and psychologists, butchers, bartenders...) consider? Apokrif 16:48, 2 April 2006 (UTC)

Only a group of psychiatrists (and psychologists, too if they'd be invited), apparently drunk on their own power, would hold a vote (and a majority vote of those in the inner sanctum is exactly how entries are made) that would deem the above to be "mental diseases." That is, after all what we are talking about here. It is a valid criticism and more than a few psychiatrists note that the DSM now includes damned near anything that anyone might possibly complain about.Homebuilding 03:05, 12 September 2006 (UTC)

I totally agree, a good amount of criticism of the percieved "medical authority" of DSM-IV is right on it's place on this page. Let's face it, the overwhelming majority of "diagnoses" in the DSM are nothing else but a collection of subjective POV's of a bunch of wealthy and influential psychiatrists, who define behaviors outside the scope of currently socially acceptable limits as "diseases" (a.k.a. "we don't like it, so it must be a disease"). It has about as much objective validity as The Dianetics or the infamous Malleus Maleficarum. The insiders are very much aware of these facts; a considerable amount of psychiatrists, with several decades of practice, have been outspoken against the practical limitations of DSM and it's validity. F. inst. the prominent and influential psychiatrist Loren Mosher stated in his resignation letter to APA that "Finally, why must the APA pretend to know more than it does? DSM IV is the fabrication upon which psychiatry seeks acceptance by medicine in general.", whilst the former APA president Robert Spitzer echoed him in an interivew, admitting "The DSM is not a scientific document.. very few of the categories have an empirical base". Unless the DSM openly states that it's labelings are unscientific/philosophical/religious and to be taken as purely subjective guidelines/alternatives in response to "troubles of daily life", it deserves to be publicly and ruthlessly exposed to the scrutiny of professional criticism. 193.217.56.24 17:29, 3 October 2006 (UTC)

Please note that Robert Spitzer, quoted just above, was and has been the driving force of the DSM--and has "founding father" status. He appointed the entirety of the initial committess and boards of the DSM. He has been the final editor of all DSM versions, up to and including the DSM IV. Once it's off his desk it is ready for the vote, up or down. He has tremendous power over how health insurance money is spent on "mental health" services as this book defines what mental health is.207.178.98.48 02:17, 12 October 2006 (UTC)

I would like to repeat that there is much more to it then finding a behavior a disease etc. as I have stated within the discrimination section of this talk article. I would like to add that there are many philosophical POVs in various forms that gave birth to the different ideas of what causes mental distress. Also, as I have said before very few disorders do NOT have the tag that it must give the individual trouble in either social, work, or liesure activity. Saying that, caffeinism is the physiological addiction as well as the psychological addiction in which the individual has withdrawal symptoms such as headaches etc that interfere with their normal functioning in which they need to consume more caffeine based products to allieviate and even act normally. Jet lag is defined as repeatedly moving from time zone to time zone in such a way which renders an insomniatic state that interferes with the individuals social, occupation, or leisure activities. Also, the comment about naming everything a disease is not truly the case. A disease has a specific definition as taken from dictionary.com for this debate "a disordered or incorrectly functioning organ, part, structure, or system of the body resulting from the effect of genetic or developmental errors, infection, poisons, nutritional deficiency or imbalance, toxicity, or unfavorable environmental factors; illness; sickness; ailment." There have been links to genetic contributors for many mental disorders including schizophrenia, alcohol abuse, opiate abuse, one particular form of insomnia etc. Though there are what are called disorders as well in which there may be a cognitive impairment that leads to an individual suffering social, occupational, or leisure activities. Finally, there are even psychologists and psychiatrists that reject the medical model and use a phenomenological approach to helping individuals with problems that are not biologically based. —Preceding unsigned comment added by UNache (talk • contribs)

Who wrote the above paragraph? EverSince 10:18, 24 January 2007 (UTC)
That would be me. Sry I haven't been around lately to show my 2-cents. UNache 5:19, 5 Feburary 2007

[edit] DSM, CBT and psychopharmacology

What about the claims that DSM was designed to (or is used to) promote cognitive behavior therapy (rather than, for instance, psychoanalysis) and the use of psychoactive drugs (e.g. methylphenidate)? Apokrif 16:54, 2 April 2006 (UTC)

[edit] Criticisms

It's worth noting, as an illustration of just how potentially subjective and socially constructed the various diagnoses in the DSM-IV are, that Homosexuality was listed as a disorder until 1973.

It's also VERY MUCH worth noting that the authors have been shown to have links to the Pharmaceutical Industry: http://www.washingtonpost.com/wp-dyn/content/article/2006/04/19/AR2006041902560.html —Preceding unsigned comment added by 24.49.244.243 (talk) 23:41, 11 June 2006

Just a few thoughts:
  1. You can't judge the objectivity of the DSM based on the example of homosexuality being listed as a disorder over 30 years ago. The field of psychology/psychiatry is a relatively young field, and in the past it was much more attached to negative social and cultural forces than it is now, as it was more dominated by "old world" doctors. It's a different situation now.
  2. Nothing can be taken from that Washington Post article. LOTS of doctors act as consultants for pharmaceutical companies. That on its own means absolutely nothing for their objectivity. If the study bringing this out is included in the article (which it was until somebody blanked it), no inference of influence can be stated.
  3. That being said, there needs to be a good section comparing the positives and negatives of the DSM-IV, but in an NPOV way.
-- Tim D 17:01, 18 November 2006 (UTC)

Will someone please provide a page on Wikipedia detailing the destructiveness of this DSM document, and the many lives it has destroyed? there are websites devoted to anti-psychiatry you might want to link to. I beg of someone! please help people who have been destroyed by this process of labelling and those in the future who will be. This document is nothing more than a political and cultural means of control. It dehumanizes the wide range of human behavior. For the love of God I wish the DSM would be discredited as the voodoo it is. Psychiatry is a huge business and most lost souls primarily need to be held and loved because of horrible things that have happened, instead are villified and ridiculed and marginalized. If anyone wants to contact me they can, at contesta@comcast.net Its not that I'm against the people who perform these jobs (I think most approach the profession with a certain desire to help), but the whole method of treating people with problems has to change. A new paradigm! 71.206.44.177 01:40, 2 January 2007 (UTC)

Why can't we just say that homosexuality might be a mental disorder, like many other things in the manual? If it was right "thirty years ago" then we haven't made any progress at all in understanding the mind if we ignore evidence because it makes us uncomfortable. I do not imagine that many people are comfortable thinking that they have a mental disorder, but hey, plenty do. It is worth noting that other explanations for homosexuality may be even less palatable. 72.144.198.53 08:50, 31 March 2007 (UTC)
For the user seeking "A new paradigm!": The page you want is called anti-psychiatry. WhatamIdoing 03:03, 10 July 2007 (UTC)

[edit] Re. merging brief 'axis ii' into DSM:Multiaxial...

I would prefer not to merge, but to keep that article as a very brief one focused on that subject (like the other axis n articles). "Axis n" are mentioned frequently in other articles, usually without explanation (except of course in the main DSM article). A person who clicks on those references more likely wants a quick explanation, rather than finding themselves in the midst of the large and complex DSM article (if they're that interested in the DSM as a whole, they probably know what the axes are already; and if they become interested in dsm via the axes, it's only one click further). Just my $0.02. —The preceding unsigned comment was added by Sderose (talk • contribs) 12:56, 8 January 2007 (UTC).

[edit] Delete Citation Needed lines

I would suggest that if references and citations cannot be provided for the lines marked, then those statements are POV and also do not meet the Wikipedia standard of being verifiable and should be deleted. DPetersontalk 14:38, 14 January 2007 (UTC)

[edit] Removal of article unreferenced tag

I removed the "unreferenced" tag at the top of the article because User:EverSince has done a wonderful job of adding sources and citations. DPetersontalk 20:01, 28 February 2007 (UTC)
I was thinking of removing the tag also, thanks. I'm also thinking of removing the unverified tag from the history section, as generally covered by the sources I think, e.g. the number of pages/disorders in each version is tabulated in the Mayes, R. & Horwitz, AV. (2005) article. EverSince 09:47, 1 March 2007 (UTC)
Yes, that tag should also be removed. regards. DPetersontalk 00:21, 2 March 2007 (UTC)

[edit] DSM-IV Sourcebooks

The DSM-IV doesn't specifically cite its sources, but there are several "sourcebooks" intended to be APA's documentation of the guideline development process, including literature reviews, data analyses and field trials. Funnily enough these key source materials for the major psychiatric "bible" of our time seem to be rarely referred to, or stocked even in major libraries, let alone read. I thought I'd post a mixture of available sources about them here before just trying to edit, since there's so much detail and perspective that somehow needs to be summarised in a balanced way.

Widiger TA, Frances AJ, Pincus Haet al. DSM-IV sourcebook. Vols 1–4. Washington, DC: American Psychiatric Association, 1997.

Volume 1 Volume 2 Volume 3 Volume 4 (possibly not even in print any longer)


The DSM-IV Classification and Psychopharmacology by authors including the guy who directed the process[5]

A Participant's Observations: Preparing DSM-IV

Critical reviews of vol 1 (appears twice) and Vol 2 by mental health professional author on reputable site.


Other articles covering the sourcebooks and DSM development:

Whither psychiatric diagnosis

PSYCHOPATHOLOGY: Description and Classification

Diagnosis and Classification of Psychopathology: Challenges to the Current System and Future Directions


EverSince 13:48, 24 January 2007 (UTC)


[edit] criticism section is really a controversy section and should be pruned

The criticism section generally brings up controversial viewpoints which are neither the majority viewpoint or the minority viewpoint. The whole section needs to be pruned. --scuro 02:35, 4 April 2007 (UTC)

What would you suggest? Maybe you could paste the section here with your suggested changes?DPetersontalk 12:25, 4 April 2007 (UTC)
This is something I have been learning about off-Wiki very recently, and I feel that we DO need to admit of the wide variety of (it seems to me) VERY valid criticism of the DSM. However it might best best to try and limit that to criticism that can be sourced in terms of WP:RS without any speculation at all? --Zeraeph 13:12, 4 April 2007 (UTC)


Don't get me wrong...antipsych critics and the CCHR have done some good in the past, especially when the mental health field was at it's early and sometimes barbaric stages.
Still the Wikipedia DSM article is not about value judgements about critics or their ideas. If they have a valid criticism that can be sourced, it belongs in the main article. Problem is, that much of what they believe can not be sourced to majority or minority sources. These ideas are simply part of a larger belief system based on a core set of values and not based on a body of evidence. They have a habit of making the "facts" fit the idea. ie Ritalin is speed.
--scuro 16:33, 4 April 2007 (UTC)


Below is a possible edit that took me a minute or two to do. Others could improve upon it. Even that edit could be pruned. This section should instead have links to other articles like Antipsychiatry or perhaps a seperate article entiled. "criticism of the DSM". Some of the deleted section was unsourced, some biased, some of it could be put into a history section....anyways the point is that the criticism section needs to not detract from the main article.
--Criticism--
The DSM was criticised soon after it's inception. Deconstructive critics assert that DSM invents illnesses and behaviors. Detractors of DSM argue that patients frequently fail to fit into any particular category or fall into several, that time limits and numbers of clinical characteristics required for a categorization are arbitrary and that attention directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment. The DSM has also been criticized for allegedly classifying behaviors that are simply uncommon in the society of that time such as homosexuality.
--scuro 16:48, 4 April 2007 (UTC)


I don't think that addresses the issues sufficiently. Here's my first cut at a version that includes more detail but tries to stay on topic:

--Criticism-- The DSM was criticised soon after its inception. Detractors of the DSM commonly argue:

  • that patients frequently do not fit neatly into any particular category, or that they fall into several;
  • that time limits and numbers of clinical characteristics required for a categorization are arbitrary; and
  • that resources directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment.

A Columbia University team headed by Robert Spitzer, an editor of the DSM, acknowledges a concern about the DSM in their annual report of 2001: “Problems with the current DSM-IV categorical (present vs. absent) approach to the classification of personality disorders have long been recognized by clinicians and researchers.” Among the problems, they list “arbitrary distinction between normal personality, personality traits and personality disorder” and point out the fact that the most commonly diagnosed personality disorder is 301.9, Personality Disorder not Otherwise Specified. [1]

Deconstructive critics assert that DSM actually invents illnesses and behaviors through the ostensible process of describing them.

The DSM has also been criticized for wrongly pathologizing behaviors that are simply uncommon or not approved in the society of that time such as homosexuality, which was described as a mental illness until 1974.[2] Based on this successful political action, some people diagnosed with gender identity disorder, various forms of paraphilia, and other "diverse states of being" hope to have these labels removed from future manuals as well.[3]

The potential for conflict of interest has also been raised. Roughly 50% of the authors who previously defined psychiatric disorders have had or have financial relationships with drug companies.[4] This criticism is normally leveled by people who oppose the use of pharmaceutical drugs to treat mental illness.


I thought that the "Eew! We're not like those people" remarks by members of one paraphilic group against members of another paraphilic group detracted from the overall point, which has nothing to do with the wide range of paraphilic behaviors or their potential for social acceptance.

The bit about half the authors having been paid to work for a drug company at some point irritates me, mostly because no one is pointing out that 100% of the editors have a "financial relationship" with an institution (the APA itself) that promotes very expensive talk therapy treatments as its bread and butter, even though talk therapy in isolation may be completely useless for some conditions. The activist charge here may be true enough, but the focus on (inherently tainted?) pharmaceutical money seems selective in a very slimy way.

What do you think? Do we have a consensus to include the details but lose the remarks? WhatamIdoing 05:01, 10 July 2007 (UTC)

[edit] Why the comment in the History section on the removal of Homosexuality from DSM?

It seems bizarre that this is here. Homosexuality is just one of many conditions. Why is it mentioned specifically here? Its inclusion looks agenda driven. I move to remove it.LCP 21:16, 24 May 2007 (UTC)

I support that DPetersontalk 21:44, 24 May 2007 (UTC)

[edit] DSM and Politics section

I addded the information that I removed from the History section. I am not sure if I have put this new section in the best place, but I think the information is important as it demonstrates how the community interpretation of a "condition" can effect how the mental health community thinks about a condition.LCP 22:15, 24 May 2007 (UTC)

Thank you for continuing to include that information; I think that it is important as well. I happened upon this page while looking for information on the removal of homosexuality from the DSM for a school project I'm working on... Just thought I'd let you know that "This American Life" (which is on NPR) recently had a show on this. I just listened to the podcast, and found it interesting, so I thought that the information might be of use here. You can find the website for that show with a quick search, and then listen to the episode from the website, if you want. The title of that episode is "81 Words". I would edit the page myself, but I don't wish to step on anyone's toes, I haven't done much editing around here in the past, and I ought to get back to writing my assignment! Anyways, I hope you find that useful, or at least interesting. Ciao! --ChatOmbre 02:45, 31 May 2007 (UTC)
Please feel free to step in. Wikipedia is a community project, and fiefdoms are contrary to the Wikipedia ethos. If you are uncomfortable publishing live, post a sample of what you want to include here, and others will comment on it.LCP 15:21, 31 May 2007 (UTC)

[edit] Fair use rationale for Image:DSM-IV.jpg

Image:DSM-IV.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in Wikipedia articles constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images uploaded after 4 May, 2006, and lacking such an explanation will be deleted one week after they have been uploaded, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.BetacommandBot 22:53, 2 June 2007 (UTC)


[edit] DSM-IV Codes

You know, I've been watching this page for a few weeks, and what I can only describe as its slow-motion revert war is getting on my nerves. Some people clearly think that it's appropriate for the DSM page to link to the DSM-IV Codes page. Some people clearly disagree. Not one of these people has bothered to do get a discussion going on the subject. Although I'm generally inclusionist, I don't really care one way or another. But I'd really appreciate it if you'd type a little note here before you make that change again, okay? Something approaching a consensus would be nice. WhatamIdoing 15:32, 23 July 2007 (UTC)

[edit] Description of the DSM-V Task Force members

"The APA has entrusted the revision of the DSM to world-renowned scientists who have vast experience in research, clinical care, biology, genetics, statistics, epidemiology, public health and consumer advocacy. They have interests ranging from cross-cultural medicine and genetics to geriatric issues, ethics and addiction. As a group, task force members have authored over 2,500 research reports, books, chapters, white papers and journal articles." This (particularly the first and third sentences) clearly consists of a positive evaluation of the membership of the task force, and not a neutral description of its composition. What is the informational value of the word "vast" here? Is there any reason for an encyclopedia to mention the number of articles published by members of this task force? Presumably someone with an interest in the DSM edited this in.—The preceding unsigned comment was added by 84.189.41.53 (talk) This clearly consists of a positive evaluation of the membership of the task force, and not a description of its composition. Presumably someone with an interest in the DSM edited this in?

Edit the entry as you see fit; due to lack of telepathy, I wasn't sure why you added the tag (I don't think you need it though, be bold and make the necessary changes; although I'm wandering... maybe they are world-renowned scientists — I have no opinion either way). Thx. El_C 22:41, 21 August 2007 (UTC)

[edit] More disease names doesn't mean more sick people

I've pulled this change:

  • Each subsequent revision of the DSM contains additional entries. It is difficult to justify the claim that there are ever-increasing numbers persons defined as mentally ill during a time when the numbers of "therapists" has exploded and the numbers and types of medications used has comensurately increased.

primarily because it's unsourced, but also because it contains a logical error. The number of newly described subtypes of mental illness doesn't say anything about the number of people who have mental illnesses. This is like saying that the world produces a billion pounds of apples each year, and if you replace the "red apples" category with the names of twenty specific kinds of red apples, that somehow the world suddenly produces twenty billion pounds of apples.

This mental error has come up before on this page. The DSM describes kinds of mental illnesses (and a few not-really-illnesses). It does not make anyone be sick or change the number of people who are sick. WhatamIdoing 21:39, 13 October 2007 (UTC)


[edit] Referencing the DSM in APA Format

Why do we have this section on "Referencing the DSM in APA Format"? Is this normal for book pages? If you look up Catch-22 or Green Eggs and Ham, is there a section on how to cite it in a bibliograph? I understand that it might be useful, but is it encyclopedic? WhatamIdoing 23:01, 18 October 2007 (UTC)

This section, I agree, is silly. I moved it to the bottom for now. I would be happy to just delete it. Perhaps it is the APA (that is american psychiatric assoc..) 'party line' on how they want their book referred to. Maybe not. However, it probably should be up to the author to choose.Expo512 (talk) 05:42, 30 November 2007 (UTC)

The "APA Format" refers to the "APA style," from the Publication Manual of the American Psychological Association, not the American Psychiatric Association. This style guide is used by a wide range of scientific publications. There are other schemes, e.g. that of the MLA (Modern Languages Association), used in other academic fields. As students are increasingly using Wikipedia as a source for essays and academic presentations, it would be a kindness to provide them with references in the form appropriate to their subject. NRPanikker (talk) 02:41, 5 February 2008 (UTC)

I understand that it might be useful, but is it encyclopedic? WhatamIdoing (talk) 17:43, 5 February 2008 (UTC)
More importantly, it's not even there now, as Athing removed it on 30/11/07 for being "unencyclopedic." It was not accurate to include the claim that DSM IV is the standard reference text for psychiatric diagnosis, since that description applies better to ICD 10. NRPanikker (talk) 16:55, 8 February 2008 (UTC)

[edit] Fair use rationale for Image:DSM-IV.jpg

Image:DSM-IV.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images lacking such an explanation can be deleted one week after being tagged, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

BetacommandBot (talk) 06:37, 2 January 2008 (UTC)

[edit] Wartime origin of the DSM

The main article does not make it clear that the postwar DSM grew out of a clash between psychiatric practice and the requirements of the armed forces and Veterans Administration during the second world war. Previously the American Medico-Psychological Association (later the American Psychiatric association) had produced, in conjunction with other bodies, a Statistical Manual which attempted to replace the diagnostic schemes used in the different state hospital systems and academic centres. This went through at least eight editions. However, it was common for a psychiatric consultation, especially with an office patient, not to lead to any clear and explicit diagnosis. Often the standard diagnoses, when applied to abnormal behaviour appearing in the extra-ordinary circumstances of the war, appeared to be wrong, in that the course of symptoms and the long-term outlook was not as expected. Many conditions that would not receive medical intervention in civilian life had to be labelled and managed, whether as diseases, crimes or breaches of discipline. The military and its hospitals found it necessary to label and tabulate many such encounters, and a couple of schemes were developed in the course of the war which returning medical officers found to be of use in civilian practice also. The introduction to the first edition of the DSM gives a brief account of that situation. The DSM-I was devised to reconcile these schemes in the days before the insurance companies acquired hegemony over American medical practice. NRPanikker (talk) 16:36, 2 January 2008 (UTC)

Is this WP:V? Can you provide reliable sources to back up this explanation? WhatamIdoing (talk) 19:11, 2 January 2008 (UTC)
My reference for the above is the first edition of the DSM, which was reprinted by the APA to mark its 50th anniversary a few years ago (2002?). I don't have it at hand right now, but will get hold of the bibliographical details soon. Presumably all this would have been discussed in the (APA's) American Journal of Psychiatry at the time, but scientific and medical libraries nowadays throw everything out after ten years, so the details may not be easy to find. NRPanikker (talk) 17:01, 3 January 2008 (UTC)
The full reference: The Committee on Nomenclature and Statistics of the American Psychiatric Association, Mental Disorders, Diagnostic and Statistical Manual Washington: American Psychiatric Association 1952 - reprinted for the APA Sesquicentennial, May 1994. NRPanikker (talk) 03:53, 4 January 2008 (UTC)

[edit] Globalization tag

I have removed the globalization tag because it is unexplained. I had a conversation a while ago with the editor who added the tag; as I recall, the editor seemed to think that:

  • the article needed to further emphasize the fact that the DSM is not the only such book/system in the entire world, so that readers would not confuse the fact that it is very widely used with the reality that other options exist;
  • the article, which is about an American book, should include more references which have absolutely no American connection (e.g., it's not good enough to be a Spanish researcher if you publish in an American journal); and
  • the sloppy statement about DSM-based diagnosis being required should be labeled as being specifically American (and IMO the editor is absolutely right on this point).

If you think that a globalization tag will result in the improvement of this article, then please restore it and explain your concerns, in detail, right here on this talk page. This will help other editors figure out how to address your concerns. Thanks, WhatamIdoing (talk) 20:47, 4 March 2008 (UTC)

[edit] Mental retardation on the axis system

Beginning with the 1987 Diagnostic and Statistical Manual (DSM-III-R), mental retardation is classified as an Axis II disorder. See [6][7][8] and about a half a million other webpages. Interestingly, this change was apparently (ultimately) the result of a lawsuit, City of Cleburne v. Cleburne Living Center.[9] WhatamIdoing (talk) 19:10, 2 April 2008 (UTC)

[edit] Some &Clarify

http://www.motherjones.com/news/feature/2002/07/disorders.html later —Preceding unsigned comment added by Ben Meijer (talk • contribs) 22:33, 18 May 2008 (UTC)