Schizophrenia: DSM V Movie review: Beautiful Mind

Yashant Sharma

Prof. Simi Ghosh

8 November 2019

 Schizophrenia: DSM V  

Movie review: Beautiful Mind

Schizophrenia is often misunderstood, mistreated and mispronounced by more than half of the times, and the definition itself has been evolving in all versions of DSM I,II,III,IV, and V respectively. The recurring patterns in which the definitions has been evolving, and yet despite leaving the discrepancies aside, with just an acknowledgement of their existence, or even worse not even acknowledging and setting rigid criterions to deem someone as schizophrenic. It makes it hard for people like John A beautiful mind. (n.d.)., an American Mathematician, Princeton Graduate, and Nobel prize winner recognised for his works in Nash theory but on the same hand find it hard to live a day in their life like an average human being. A beautiful mind is a depiction of life of John Nash, not a novel prize winner, but a schizophrenic patient, who indulges in canonic behaviour and vividly describes characters that are non existent, and hallucinates about top security missions that he leads in his secret life, solves codes for the US army, but fails to live a peaceful life, give his own son baths, help his wife in daily chores, or even go on job. john, is often amused by patterns and he cuts magazines and newspapers, and indulges in cobweb like patterns of solving mysteries, imaginary people, and when asked in reality, he finds it hard to confront his own thoughts, and is often strangled between a swarm of his own dialogues. With such ambiguity in the way, how this disorder- Schizophrenia is termed and the awareness about it which is disseminated, not only makes it hard for people like John to get the correct and effective treatment but also, questions the credibility of medical professionals who may struggle to find the right approach, or the caretakers who look after these patients. Schizophrenia is conceptualised as a psychotic disorder and thus requires simple psychotic pathology in the diagnosis. Researchers have also claimed that delusions, hallucinations and disorganised speech are core “ positive symptoms” which can be highly reliable and might reasonably considered necessary for reliable diagnosis, but this is alarming for patients who might not even be schizophrenic .  The new DSM V model not only eliminated that, but also further dwells deeper into the discrepancies and they were either deleted completely like Notes in Criterion 1, or were edited. Below are the changes that were updated in the list of Criterions in DSM V, on how someone with schizophrenia can be diagnosed.

Criterion A. Characteristic symptoms: (Minor change)
Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated).At least one of these should include 1–3

1.Delusions

2. Hallucinations
3. Disorganised speech
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms (i.e., diminished emotional expression.

Criterion F. Relationship to Global Developmental Delay or Autism Spectrum Disorder — Minor Change
If there is a history of autism spectrum disorder or other communication disorder of childhood onset, the additional diagnosis of schizophrenia is made only if prominent delusions or hallucinations are also present for at least 1 month (or less if successfully treated). 

These definitions clearly require more robust criteria, to define and diagnose the disorder, shortcomings of the current model can be numbered, but finding an approach which is more valid, reliable, and useful at the same time. Reports around the world have stats claiming the diagnostic agreement or reliability that DSM-III, and ICD have touched upon, and hence reported improved diagnostic communication ad consistency of health statistics. There was an extensive review of schizophrenia against a range of validating criteria, including shared genetic risk factors and familiarity, environmental risk factors, gene–environment interactions, neural substrates, biomarkers, temperamental antecedents, cognitive and emotional processing abnormalities, comorbidity, illness course, and treatment response(Tandon, et al., 2013) . Apart from this, there have been concerns regarding dissection of the varied nature of schizophrenia, both in terms of etiological factors and pathophysiological mechanisms due to lack of specific boundaries when it comes to diagnosis and characterising a patient under the aforementioned term. However, and the new dimensions approach appears to be the most promising method towards resolving this disease admixture.These changes will not only improve diagnosis and characterisation of individuals with schizophrenia. It will  co-facilitate measurement-based treatments by providing a more useful platform for researchers and practitioners that will elucidate its nature and permit a more precise future delineation of the ‘schizophrenias’.