The authors consider arguments for and against the formal inclusion of mentally ill patients and their families in the deliberative processes leading to DSM-V. These discussions involve six key issues: the scientific status of psychiatric classifications; public policy and political considerations; the practical implications of widening the review process; the capacities of lay members of the workgroups; freedom of expression and the openness of the review process; and the uniqueness of consumer perspectives. The authors conclude that involving patients and families in the DSM review process is supportable on both scientific and public policy grounds.