All mixed up: On the absence of diagnostic guidelines for mixed states in the ISBD Diagnostic Guidelines Task Force Report

摘要

Nietzsche once said that truth is a mobile army of metaphors (1). It may be that the entirety of DSM-IV and ICD-10 are brigades of metaphors for the complex problems presented to clinicians by patients. [In a sense, every classification is an act of injustice (M. Perlman 2007, personal communication).] Indeed, every illness is a metaphor - even unambiguous physical diseases like cancer or tuberculosis (2); yet metaphors are not necessarily false, just complex; and some are more readily accepted than others.