Since 1950, man has landed on the moon, made computers commonplace and harnessed nuclear power. We’re obviously using our minds to the fullest. Yet the number of ways we can go officially crazy has nearly tripled. The hugely influential reference book used by psychiatrists and other mental health professionals the world over to diagnose mental illness — the Diagnostic and Statistical Manual of Mental Disorders — currently lists 357 types of psychiatric afflictions, up from 128 when the first volume was published in 1952.
Two Jews may, as the saying goes, have three opinions, but that appears to be a fairly modest ratio when compared with psychiatrists. It was inevitable that revisions to the Diagnostic and Statistical Manual of Mental Disorders would invite controversy—it’s the classic reference work for mental-health professionals, and a convenient field guide to understanding crazy exes for the rest of us—but even the American Psychiatric Association, which first appointed the work groups to update the text two years ago, couldn’t have predicted the squabbles now under way.
DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift”. Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system – stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.
Patrick McGorry claims that early intervention for psychosis has much better outcomes in terms of return to work and quality of life, but his own data in a Schizophrenia Bulletin paper last year show no significant differences.
Proposed updates to the Diagnostic and Statistical Manual of Mental Disorders (DSM) are prompting many to question whether or not the psychiatric profession itself has gone crazy. The latest additions to the alleged “mentally ill” could include hoarders, people who get angry every now and again, lazy people, and even those who get outraged over things like sex and violence on television.