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.


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4 Responses to DSM 5: The debate over what is a “mental illness”

  1. johnnybe says:

    Mental disorder is a lot of thing to a lot of people, to some its,emotional+ feelings+ conditioning+ lessons+Psychological+thinking+ current situation+Circumstance+ history+ chemicals+genealogy+ Environment+ influence+ behavioral+alcohol+diet+drugs, etc etc,all these factors will play a part in the wellness/unwellness of all people,
    All these factors must be taken into account in the nurturing and healing of all people
    In order to determine what troubles an individual carers need to start with emotional psychological, the thinking feeling factors.
    There is/are always reasons for the concerns or troubles we all think,feel and are effected by.
    Chemical imbalance is the result of all these conditions.
    When you ease the effect with the total lessons treatment of care the chemicals will change in a natural way, they are only one aspect.
    When you forcefully add a synthetic chemical you will upset the person and their natural “everchanging” chemical balance.
    If you at the same time disturb oppress or break the spirit or heart of the person, you will only serve to further disturb or trouble them, and further increase their need to address all the areas of concern and healing.
    You will in effect make their condition far greater in terms of need because being vegetated against your wishes and called horrible nasty names weakens you and reduces your self esteem at the same time,it almost makes it impossible to access your concerns as well or even think about them. Or get any care because of the alienating debilitating condition of chemicalisation,with these effects as well tiredness, pain,oppression, sadness,lethargy,insulation,isolation, and then on top of all that to be seen as mental and ill by your family, your friends, and the community,and further alienated, sorry but its just not good enough or right

  2. Z. Agbah says:

    Not all psychiatric medications cause those taking them to ‘vegetate’. I myself find that my medication helps me from becoming a walking zombie. However I take your point that the new DSM must be compiled as comprehensively as possible. I have trouble with this article; the blogger’s use of the word ‘normal’ concerns me, as it makes people suffering mental illness seem abnormal, and therefore, the ‘other’. It becomes an ‘us and them’ situation, when inclusivity is what we with mental illnesses, disorders, whatever the ‘experts’ wish to call it, need more than anything. I wonder if the compilers of this new DSM have actually consulted any people with mental illness and asked for their opinions? Perhaps that would go some way to discerning different symptoms and their descriptions. Anyone suffering with mental health issues can tell mental health professionals what their symptoms are, what early warning signs to look out for, what are the benefits and drawbacks of each medication they are on. But the psychiatric profession apparently thinks it knows better than the person actually experiencing the mental distress. I find that a crying shame.

  3. johnnybe says:

    Yes your right about vegetated, thats only one of an average forty side effects per psychotropic though, and is only one example. Look up any psychotropics side effect’s and you can always find at the least, another thirty nine debilitating side effects,some have sixty, not everyone suffers from them all, but normal caring only vested in love and care people would believe you if you reported what they were doing to you wouldn’t they? and if they didn’t cease doing it to you what sort of people would they be? Psychiatrists of course.

  4. michael Bromberg says:

    ” 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.”

    Normal, in this context, is meant to mean those that do not have such
    a disorder. Clearly, normal is a word that can be taken the wrong way
    when you are discussing mental disorder, since those that are “not
    normal” then sound to be inferior. The slippery slope with mental
    disorder is that some people may act wacky or have troublesome
    “symptoms” but may actually have no chemical imbalance or any
    scientifically measurable difference between them and a random John
    Smith. Some people are just “eccentric” but that doesn’t mean they
    have a disease. The challenge with a book like the DSM is that it
    attempts to categorize something in which we seem to still know very
    little about and the inner workings of what goes into a book like that
    have historically been at least partly political. A book like the DSM
    has the power to determine who is “normal” and who is not and that, as
    you can imagine, is a scary thought. Thanks for your comments!

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