Whose Planet Is It Anyway?

Wednesday, November 19, 2008

Sausages and Legislation

…and the diagnostic categories in the Diagnostic and Statistical Manual of Mental Disorders (DSM) all have one thing in common: You will be seriously disgusted if you look too closely at how any of them are made.

In a Los Angeles Times article, Christopher Lane, a Northwestern University professor, describes an ongoing controversy among psychiatrists as to whether the next revision of the DSM should be open for public discussion or whether it should be a secretive, closed-door process. Lane writes:

Hanging in the balance is whether, four years from now, a set of questionable behaviors with names such as "Apathy Disorder," "Parental Alienation Syndrome," "Premenstrual Dysphoric Disorder," "Compulsive Buying Disorder," "Internet Addiction" and "Relational Disorder" will be considered full-fledged psychiatric illnesses.

This may sound like an arcane, insignificant spat about nomenclature. But the manual is in fact terribly important, and the debates taking place have far-reaching consequences...

...Because large numbers of countries, including the United States, treat the DSM as gospel, it's no exaggeration to say that minor changes and additions have powerful ripple effects on mental health diagnoses around the world.

Behind the dispute about transparency is the question of whether the vague, open-ended terms being discussed even come close to describing real psychiatric disorders.

Lane writes that he is concerned about the lack of solid science, the lack of proper oversight, and the need for a vigorous debate about the validity of any proposed disorders. He describes, in scary detail, the chaotic and scientifically unsupported discussion that went into the creation of new diagnostic labels in previous editions.

This is how I see it: At present, we live in a society where large numbers of our citizens, without any say in the matter, have been assigned mental disorder classifications on the basis of scientifically questionable and often biased research studies. We face widespread prejudice and discrimination as a result of these arbitrary classifications and the resulting stereotypes. Our psychiatric emperors and their drug-company courtiers wield vast power over our lives, while their scientific nakedness usually goes unmentioned. It's time for concerned citizens to put an end to the ugly and morally indefensible caste system that they have created in secret.



  • The.best.blogpost.ever.

    My husband has called psychiatry modern voodoo for years.

    I do appreciate the good drugs, however. It's the "soma" from _1984_, that anesthetized the masses.

    By Blogger Usethebrains Godgiveyou, at 2:58 PM  

  • Yet it (DSM) has created such a Catch-22 for so many people (esp. children in school). Without the classification, many are denied any sort of authorization for approved (yet non-medical) therapies (including PT and OT) and schools are both reluctant and inconsistent about assigning an educational diagnosis/classification to enable students access to the services they need.

    Where is the middle ground that can meet the genuine needs of many people while keeping everything from becoming medicalized (is that the right word?) and micromanaged by insurance companies?

    By Blogger Niksmom, at 3:36 PM  

  • There's a response to this on my blog:

    By Blogger stopbeingstupid, at 4:09 PM  

  • A discussion from the DSM V committee on PDD's at


    Makes interesting, if somewhat long-winded reading.

    But the final paragraph is indicative:

    The third breakout group made the following recommendations: 1) delete Asperger’s disorder; 2) delete CDD; and 3) create an ASD with two types: Type I would be for prototypical cases characterized by problems in social interaction, social communication, and repetitive behaviors or preoccupations, and Type II is for atypical cases. Data needed to inform such a decision include: 1) the number of criteria to be met for Type I and Type II (at least one in each category); 2) core symptomatology over various ages and developmental stages; 3) clarification of the requirements for diagnosis in females and diverse cultural groups; 4) a definition of impairment at different ages and developmental stages; and 5) consideration of effects of IQ and of comorbid diagnoses. Other specific suggestions include: 1) determining whether obsessive-compulsive symptoms occurring in ASD are part of the ASD or warrant a separate diagnosis of OCD; 2) removing the ADHD exclusion; 3) adding better examples for criterion items across the lifespan; 4) adopting a better definition for regression; 5) determining whether ASD remits and what a residual state might look like; and 6) consider genetics as a modifier versus continuing to code it on Axis III.

    By Blogger Socrates, at 4:14 PM  

  • Rose: Thanks. I agree that there are some "good drugs," or, at least, drugs that can be good for some people; but it's scary how random the process of prescribing drugs is.

    Niksmom: I think you've got it exactly right -- schools need to employ educational psychologists and other professionals who can assign useful educational classifications and provide therapies as appropriate.

    Sanabituranima: I think you may be conflating Lane's views with mine. I'll respond in more detail on your blog later.

    Socrates: Thanks much. Interesting reading indeed.

    By Blogger abfh, at 6:03 PM  

  • The minute they make the revision a closed-door process, that's when psychiatrist should be treated with the utmost scorn.

    By Blogger David N. Andrews M. Ed., C. P. S. E., at 8:44 PM  

  • Like Sanabitur Anima, I also think psychiatry has a core function that is absolutely essential, and that allows lots of people who would otherwise be miserable to have full, reasonably happy lives. (I am depressed and autistic; I see one as a chronic disease and the other as part of my identity).

    Ideally, psychiatrists (and all doctors!) would get to know their patients fairly well, and make their judgments according to what's normal for that person instead of using some abstract standard for all people. It's this refusal to dig deeper that I think lies at the root of overdiagnosis and overprescription, as well as the ridiculously bad science of BMI (and the abuses chronicled on this blog) and the long-standing neglect of the medically relevant ways in which women's bodies differ from men's (like, say, in the initial symptoms of a heart attack). I blame the insurance companies and our profit-driven healthcare system for creating incentives for shortcuts and quick fixes rather than finding out what's really wrong, if anything, and treating that.

    (Also, because I am a huge pedant: RB, it was Brave New World that featured soma, not 1984).

    By Blogger Lindsay, at 10:05 PM  

  • To clarify, I am not anti-psychiatry.

    I am anti-unscientific-psychiatry, anti-bigoted-psychiatry, and anti-coercive-psychiatry. But I don't believe that these abuses are inevitable.

    As I see it, psychiatry has the potential to become much more useful than it is today, if it can ever get its act together.

    By Blogger abfh, at 11:19 PM  

  • Well, I don't believe Asperger syndrome (or stuttering or Tourette's) belong in a manual of "mental disorders" as these are not mental illnesses, but are neurological conditions, but at the same time I'm never siding with the anti-psychiatry extremists who say there is no such thing as mental illness, and I'd never agree with the ignoramuses who say that AS is just a fad and not a real difference.

    The shit would hit the fan if any shrink gets the smart idea of adding synaesthesia to the DSM, but I've got to say, if conditions that are as obviously neurological as AS and stuttering are considered to be "mental disorders", and a condition as trivial as hair-pulling is in the DSM, then there is little justification for not including synesthesia as well.

    Toss the stupid book in the skip and get on with life, that's my advice. We could organize mass book-burning ceremonies to commemorate the new edition. I'd be in that.

    By Blogger Lili Marlene, at 12:20 AM  

  • It's interesting at the moment to see that as public awareness of synaesthesia is still growing, a few signs that some people are categorizing it as some type of impairment or mental problem are appearing. I'm of the opinion that because of the way society already regards conditions such as autism and ADHD, it is naive to think that public awareness of synaesthesia can grow without the condition falling victim to many negative assumptions, even though all of the experts on synaesthesia clearly state that it should not be thought of as a disorder.

    By Blogger Lili Marlene, at 12:29 AM  

  • a friend and i have been talking a lot about this in regards to gender and being trans. so good to hear this perspective too.

    yes yes yes.

    By Blogger cripchick, at 1:54 PM  

  • I've got to come back to read the comments here. I think it is important that the "validity" of some aspects of psychiatry be exposed. In some ways we've moved forward from the "Bedlam" days but it some ways not. (cough, cough..."JRC"...cough.)

    I want to thank you for the answer you gave on my blog that I can give to my son. It is so enormously hopeful, and something Ben would love to hear. It's like he doesn't need to "give up his dreams" to survive in this world. It was very kind of you to take the time.

    By Blogger Usethebrains Godgiveyou, at 7:21 PM  

  • Thanks for your comment on my blog. Here's my (belated) re-response

    By Blogger stopbeingstupid, at 5:22 PM  

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