A startling suggestion is buried in the fine print describing proposed changes for the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — perhaps better known as the D.S.M. 5, the book that will set the new boundary between mental disorder and normality. If this suggestion is adopted, many people who experience completely normal grief could be mislabeled as having a psychiatric problem.
With drafts of the latest edition of the world’s leading psychiatry manual emerging, critics question the growing medicalisation of life’s problems. Over the past three decades, unhappiness has been redefined as depression, shyness has been reclassified as social anxiety disorder – even trivial complaints such as fussy eating are now being viewed through a psychiatric prism. Some of this is due to a single book, the Diagnostic and Statistical Manual , which critics claim is contributing to the ever-expanding empire of mental health. The next official edition of the DSM will be published in May 2013, but draft versions are currently doing the rounds.
McGorry and Mendoza are adept at capturing media attention, using emotive statistics and feel-good messages as powerful soundbites. However, few people seem to have critically examined their claims, which have been widely accepted at face value. We have examined several claims, and found them seriously problematic. Not only is there a high degree of spin in the rhetoric but also there is misrepresentation of evidence.
The “Psychosis Risk” proposal has stimulated widespread opposition (even I am told from within the Workgroup itself). The arguments against it are simply overwhelming. The false positive rate in predicting psychosis would be between 70-90%, meaning that between two and nine youngsters would be misidentified for every one accurately identified. The treatment most likely to be used would be antipsychotic medications. These have no proven efficacy in preventing psychosis, but most definitely have terrible side effects- especially enormous weight gain and its life threatening complications. These medications are overprescribed to those least able to resist- the young and those who are most financially disadvantaged.
The Diagnostic and Statistical Manual, whose updated fifth edition will include a range of new diagnoses, is a mythology, not a scientific text. It is created by American psychiatrists who meet in groups to consider whether or not a certain diagnosis should be included in the DSM. These groups meet a number of times so that they can say that their agreement about a certain diagnosis is reliable. Thus they could reliably agree that there is a mental disorder called Guardian Readers’ Personality Disorder with the symptoms of a need to read this paper regularly, an overvaluation of the Guardian, and so on. Who knows, it might already be in the most recent version of the DSM.