DSM 5: The debate over what is a “mental illness”
Science shouldn’t be a term used loosely. It should, at minimum, be indicative of using a definitive method which includes observation, ask a question, form a hypothesis, analyze results, control groups, statistical methods, case study, and/or other avenues to come to conclusions that ultimately give doctors the logic, reason, and knowledge behind their medical decisions.
Mental illness has been highly controversial in terms of what it really is, if anything, and what should be done about it. Some people, like one of my psychology professors in college, do not even believe there is such a thing as a mental illness. He would argue that there is “mental disorder” but to say it is an illness is another matter because illness insinuates the problem is of biological origin, which might not be the case.
Since 1952, a tome called the Diagnostic and Statistical Manual of Mental Disorders, better known as the DSM, has been reducing to a few digits the psychological malady said to afflict a patient.
Everyone can have a code that refers to something in this book because life always throws us curveballs and we have to adjust.
This bible of mental health treatment, published by the American Psychiatric Association (APA), provides a list and description of every mental health condition known to—or invented by—psychiatry, from histrionic personality disorder (301.50) to transvestic fetishism (302.3).
Over the years, there have been significant revisions to this book. It may come as no surprise that homosexuality, for example, was once considered a mental illness.
The newest edition of the book, The DSM-5, is slated to come out in 2013 and it is causing all kinds of commotion from professionals and academics in terms of its scientific validity.
The problem is simply this: If you reduce the symptoms on something, then psychiatrists are more likely to give a diagnosis for it and then many people who might actually be normal will then be labeled with this disorder and may then be taking medications for it. This is great news for the pharmaceutical industry but bad news for the poor soul that went to the doctor for some help and then ended up finding out they now have a ‘code’ that the insurance company will put in their file to document whatever the doctor diagnosed.
An article from salon.com tells us about a committee created to discuss objections of the new DSM formed by David Elkins, professor emeritus at Pepperdine University and president of the Society for Humanistic Psychology, a division of the American Psychological Association. In October, he posted the petition online. “I figured we’d get a couple hundred signatures,’’ Elkins said.
Much to his surprise, the petition attracted more than 6,000 signatures in three weeks; as of mid-December it had topped 9,300 signatories and garnered the endorsement of 35 organizations.
It turns out not just the humanistic psychologists are concerned.
For many critics, Exhibit A is childhood ADD. As the disorder describing fidgety, easily distracted kids morphed from “hyperkinetic reaction of childhood” to the current “attention deficit hyperactivity disorder,” the number of children given the diagnosis exploded, fueling, by one account, a 700 percent increase in the use of Ritalin and other stimulants in the 1990s. Diagnosis requires checking six of nine boxes from a list of symptoms that include “often does not seem to listen when spoken to directly” and “often fidgets with hands or feet or squirms in seat.”
I may not be a parent, but I know that children who do not seem to listen when spoken to directly may actually be perfectly normal people.
Hence, humanistic psychologists are doing what they can to prevent new revisions that basically make it looser for psychiatrists to diagnose certain issues and thereby creating a false explosion of the so-called illness.
The most surprising critic of the DSM is a one-time pillar of the psychiatric establishment. Allen Frances, professor emeritus at Duke University, chaired the task force that created the DSM-4. Now he’s railing against both the process and proposed content of the new DSM in blogs on the website for Psychology Today that blast the new revision as “untested” and “unscientific.”
“DSM has to be a safe, reliable and credible guide to current clinical practice,” he says. “It can’t be an untested program for future research.’’
Well said—this needs to be based on sound research and I hope this research comes from independent sources that are not funded by the drug companies. Politics? Oh yes, you can bet that has happened in the past and will certainly happen in the future.
Unfortunately, the research is still mixed in reference to the origin of mental disorder. Is it genetic? Is it a product of environment? Is it a little of both? We are still seeking answers to these questions.