Tag Archives: diagnoses

The DSM—New psychiatry manual adds to the oversupply of invented victims

In 1952, the Diagnostic and Statistical Manual of Mental Disorders – the DSM – psychiatrist’s bible for diagnosis of mental problems, was a 132-page booklet. Today, in its fourth incarnation, it is a 886-page doorstop. Controversy is now swirling over the fifth instalment, slated for publication in May 2013.

It seems that every DSM upgrade contains more and more “disorders” that are open to question for their vagueness and open-endedness.

The New York Times on Psychiatric Disorders, “Not Diseases, but Categories of Suffering”

YOU’VE got to feel sorry for the American Psychiatric Association, at least for a moment. Its members proposed a change to the definition of autism in the fifth edition of their Diagnostic and Statistical Manual of Mental Disorders, one that would eliminate the separate category of Asperger syndrome in 2013. And the next thing they knew, a prominent psychiatrist was quoted in a front-page article in this paper saying the result would be fewer diagnoses, which would mean fewer troubled children eligible for services like special education and disability payments.

Then, just a few days later, another front-pager featured a pair of equally prominent experts explaining their smackdown of the A.P.A.’s proposal to eliminate the “bereavement exclusion” — the two months granted the grieving before their mourning can be classified as “major” depression. This time, the problem was that the move would raise the numbers of people with the diagnosis, increasing health care costs and the use of already pervasive mind-altering drugs, as well as pathologizing a normal life experience.

Fewer patients, more patients: the A.P.A. just can’t win. Someone is always mad at it for its diagnostic manual.

The Illusions of Psychiatry

Not only did the DSM become the bible of psychiatry, but like the real Bible, it depended a lot on something akin to revelation. There are no citations of scientific studies to support its decisions. That is an astonishing omission, because in all medical publications, whether journal articles or textbooks, statements of fact are supposed to be supported by citations of published scientific studies. (There are four separate “sourcebooks” for the current edition of the DSM that present the rationale for some decisions, along with references, but that is not the same thing as specific references.) It may be of much interest for a group of experts to get together and offer their opinions, but unless these opinions can be buttressed by evidence, they do not warrant the extraordinary deference shown to the DSM. The DSM-III was supplanted by the DSM-III-R in 1987, the DSM-IV in 1994, and the current version, the DSM-IV-TR (text revised) in 2000, which contains 365 diagnoses. “With each subsequent edition,” writes Daniel Carlat in his absorbing book, “the number of diagnostic categories multiplied, and the books became larger and more expensive. Each became a best seller for the APA, and DSM is now one of the major sources of income for the organization.” The DSM-IV sold over a million copies.

Shrinks on the couch as they ponder who is and is not crazy

SOME psychiatrists — the ones who don’t believe they are godlike creatures — are in a bit of a tizz these days. They are worried about all the damage they might have unwittingly done by misdiagnosing mental illness. Libyan leader Colonel Muammar Gaddafi could help to ease their furrowed brows. Some background, before I explain that apparent non-sequitur: In a soul-searching analysis of his profession in Wired magazine recently, US psychiatrist Dr Allen Frances declares that mental disorders “can’t be defined”, and it’s “bull—-” to suggest otherwise. Frances is lead editor of the DSM-IV, the fourth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual. It’s a publication that has been described as “the bible” and “the imperial doctrine” of psychiatrists.

It’s what shrinks use, in their godlike wisdom, to decide whether or not you are mentally ill — and then to prescribe powerful, dangerous drugs, and other treatments that can turn you into a shadow of your former self. In the gut-wrenching Wired article, Frances says: “We psychiatrists have made mistakes that had terrible consequences.”