This isn’t the first article on debates about the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM), and it won’t be the last. The DSM is the guidebook that is used by therapists and counselors to diagnose their patients’ mental health status. The guidebook, which is revised every few years, features detailed symptoms and criteria that funnel individuals from broad diagnoses (“bipolar,” “personality disorder”) to specific subsets (“Axis II” or “Cluster B”). There’s much debate over whether these categorizations actually help the patients themselves. On the up side, labeling a problem can provide perspective and offer “the answer” a person was looking for. On the down side, labeling problems often turns into labeling people (pathologizing) and can, as Gary Greenberg writes, “chalk up life’s difficulties to mental illness.”
This latter point has been getting a lot of press lately. One of the most outspoken opponents of new changes to the DSM is Allen Francis, the man who spearheaded the manual’s previous revision and has come to regret where several of those revisions have led. Under his watch, the DSM opened up diagnostic criteria to address varying degrees of severity. For example, Francis noted that some people experienced a mild form of autism, known as Asperger’s syndrome, which interfered with social functioning but not much else. Though studies showed that Asperger’s was “vanishingly rare,” its inclusion in the DSM preceded a tidal wave of Asperger’s diagnoses. Similar trends were echoed in the areas of bipolar disorder and ADHD.
The problem, as Allen Francis and other critics see it, is not that these aren’t real conditions that warrant evaluation and treatment from counselors and psychotherapists. These are, in fact, very real struggles faced by people the world over. The problem is that these problems are over-diagnosed and over-treated. Students who exhibit social awkwardness, if diagnosed with a form of autism, are eligible for specialized services and classroom support. Adults diagnosed with bipolar can get prescriptions for mood stabilizers and antipsychotic drugs, which benefit pharmaceutical companies, many of whom have aggressively marketed their mood-related drugs since the last DSM update.
So the problem remains: is it better to broaden the definitions of mental health disorders, so as to allow treatment for people who aren’t eligible for treatment without a diagnosis? Or is it better to play it safe: to, as Will Meek puts it, “look for horses before zebras” when you see footprints? In other words, to look for real life problems—trouble with family, work, relationships, and stress—before looking for a diagnostic label. The debate continues.
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