The DSM Disputes

As we near the final publication of the most up to date addition of the DSM (the Diagnostic and Statistical Manual of the American Psychiatric Association, set to be published in May of 2013) the media is already following the story of some of the inevitable controversies that will arise as a result. For example, in just one week, the Autism community was upset because the diagnostic criteria has been changed such that fewer individuals would meet the definition for Asperger syndrome and therefore will become ineligible for benefits and services. Similarly, the bereavement exclusion under the diagnosis of major depression is also about to change, with the effect of pathologizing what many believe is a normal response called grief and thereby rendering a lot of grieving people “mentally ill” and eligible for treatment with psychotropic medications (no doubt a boon for the pharmaceutical industry).

The truth is, no psychiatric illness is a “real disease” like measles or cancer. In fact, the DSM itself tries to address this issue in its very pages. In the introduction of the DSM, it states “no assumption that each category of mental disorder is a completely discrete entity with absolute boundaries dividing it from other mental disorders or no mental disorder.” And yet, people still take the content of the DSM literally.

In my opinion, the problem with the DSM is that it has always tried to be an objective reflection of psychological pathology, seeped in science and the medical model. It strives to be a manual that reflects a materialist perspective on reality, when in fact it simply categorizes symptoms based on largely subjective assessment. When the field of psychiatry embraces its psychological roots and retreats from pure brain materialism, perhaps there will be less controversy surrounding the DSM. In the mean time, it’s what we have, and what we will continue to use to define the field of mental illness, with profound implications for consumers and providers alike.