Seeking legitimacy for DSM-5: The bereavement exception as an example of failed process

Abstract

In 2013 the American Psychiatric Association (APA) published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Even before publication, DSM-5 received a torrent of criticism, most prominently over removal of the “bereavement exclusion” for the diagnosis of major depression. We argue that while the APA can claim legitimate authority for deciding scientific questions, it does not have legitimacy for resolving what is ultimately a question of ethics and public policy. We show how the “accountability for reasonableness” framework for seeking legitimacy in health policy could have been used to achieve a better resolution of the conflict than actually occurred.