DSM 5 Controversy

Some of you may know that the American Psychiatric Association (APA) publishes a manual that outlines all the major mental illnesses  The book is known as the Diagnostic and Statistical Manual of mental disorders.  The first manual was issued in 1952 and this is the fifth version and has come with a lot of controversy.

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The DSM was created as a way of cataloging and naming mental illnesses and giving definitions and standards for diagnosis.  Some of the more common mental illnesses in the DSM include schizophrenia,  major depressive disorder and bipolar disorder.  Each illness is defined and then specific criteria need to be met for a diagnosis to be made.

There are numerous critiques but the main one happening now is that there is an increasing pattern of overdiagnosis of disorders.   The DSM has grown from describing 106 disorders  (from the first 1952 publication) to now diagnosing more than three times that much.  As the number of diagnosable illnesses have grown, pharmaceutical companies have increasingly developed medications for these new diagnoses.  Now 20 percent of Americans take psychiatric medications, a massive increase in the past few decades.  One of the main critiques of the DSM is that those who helped publish it are complicit in overmedicating society.  This critique is given greater weight because a majority of the panel that creates the DSM have ties to pharmaceutical companies.

The new DSM has a number of new diagnoses including Internet addiction, skin picking and binge eating.  Though these can be problematic, they may apply to such a large swath of society that in essence most of us are labeled mentally ill. Furthermore, these new diagnoses become an entry portal for even

further treatment by psychiatric medications.  The normal patterns of life which include sadness (major depressive disorder), deep grief over loss of a loved one (bereavement disorder)  and anger over being traumatized (post traumatic embitterment disorder) become new diagnoses and medical conditions to be treated.  Normality is becoming medicalized.

A further critique of the DSM is that there is no scientific evidence with biological or neurological markers for any of the illness patterns they describe.  In essence it’s a medical manual without any substantiating evidence.  Previous theories such as dopamine or serotonin imbalances and deficiencies have shown to be inadequate.  Furthermore, the medicationsfor these illnesses have not been shown to “fix” or heal any underlying biomedical condition that underlies the mental illness.

There is a counter argument to the DSM V that diagnoses are not so cut and dried and perhaps not even necessary.  Often people are being prescribed medication and given therapy and then a diagnostic code is entered into paperwork as an afterthought in order to receive insurance coverage.  If practitioners are uncomfortable with diagnostic labels, perhaps it’s time to rethink the notion of labeling people.  Each person has a unique experience and mode of expression and a diagnostic label does not adequately describe that experience.  Instead it lumps large groups of unique and different people into one category.

The DSM is researched by numerous doctors and professionals, most of whom have ties to pharmaceutical companies.  Often these companies pay these professionals to give lectures and promote their medicines.  This conflict of interest has led to the suspicion that the DSM is tainted by industry involvement.  To solve this issue, it would be smart to disengage the doctors from the pharmaceutical companies by no longer taking money to promote their medicines.

Overmedication, lack of biological markers for identifying illnesses, arbitrary classification and rapid increase in the amount of disorders, as well as industry ties to the professionals who published the new DSM are all reasons that our system for treating mental illness needs to be examined.

 

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