In early 2009, after the inauguration of President Obama, Newsweek magazine ran a cover showing two hands shaking, one red and one blue. The caption read, "We're All Socialists Now!" Not wanting to be left out of this inclusive is the American Psychiatric Association which is in the process of introducing a new diagnostic manual which, presumably, could leave the overwhelming majority of the population open to mental health diagnosis. Let's prepare to welcome the new DSM!
Anyone involved in the mental health field knows what the DSM is. The Diagnostic and Statistical Manual of Mental Disorders is a publication of the American Psychiatric Association that was initially intended to be a set of guidelines for researchers who needed pure definitional criteria of mental disorders. For example, if one wants to study the effectiveness of a treatment for depression, then one needs to know as clearly as possible what the symptoms for depression are. Further, one needs to be able to distinguish those who do not have the condition, so that they are not inappropriately introduced into the study.
This attempt to operationally define mental disorder really took off in the early 1980s with the introduction of the Third Edition of the DSM. About the same time, health insurers started using DSM codes as a way to track expenditures. Later it became customary for insurers to use these same codes to eliminate whole categories of diagnoses from the lists of those for which they were willing to pay. (One insurance executive told me, "If we don't pay for them, they lose their jobs. If they lose their jobs, they lose their insurance. If they lose their insurance, they're not our problem." In a fateful twist of irony that proves that God really does have a sense of humor, that same executive lost his job within months of that statement.)
Now the mental health community awaits the release of the Fifth Edition of the DSM. The story linked below from Reuters suggests there are concerns that, with this new edition, almost everyone will have a diagnosable mental disorder. As I see it, this is the result of a couple of factors. Psychiatry is in grave danger as a profession, with fewer medical students each year showing any interest in the field and pressure mounting by psychologists to obtain prescription privileges (something I vigorously oppose, by the way). As a result, I suspect that this broadening of diagnoses to included many who would be otherwise considered "normal" may be driven by the desire to expand those items for which mental health professionals may gain reimbursement.
However, lurking amidst all of this is something that I think is very dangerous. I worry that we may be on the precipice of entering a "soviet-style" of psychiatry where the holding of politically-incorrect positions can be classified as mental disorders. If we are going to start including "Temper Dysregulation Syndrome" into our diagnostic nomenclature, what is to stop us from expanding our possible patient base to include people who suffer from a syndrome that is defined by "excessive rigidity of thought in that the individual holds inflexible exclusive beliefs in a deity"? Do you think that can't happen? Think again. I know several very intelligent people who would support such a position.
The point to all of this is pretty simple. When the mental health Brahmans decide that they want to include diagnoses that resist operational definition, then they open up our fields not only to ridicule from a public that understands that most of this is of little use, but also to exploitation from those who would use the mental health field for self-serving ends.
Here's the link.
Mental health experts ask: Will anyone be normal? | Reuters