The so-called bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders, is getting a make-over. The latest version, DSM 5, will come out in 2013. In the meantime, conflicts over which diagnoses should be added, removed or changed are heating up.
The arguments against DSM-5 are really quite simple and straightforward — and to me seem absolutely compelling. DSM-5 has failed to allow an open, independent and rigorous scientific review of the evidence supporting its suggestions. It is the result of a secretive and closed process that has lost touch with clinical reality. Its suggestions for new diagnoses and for reducing thresholds on old ones will promote a radical explosion in the rates of psychiatric diagnosis that will worsen our country’s already excessive use of medication. Finally, the DSM-5 preoccupation with diagnosing disorders in people who are not really ill will result in a misallocation of resources that disadvantages those most clearly in need them.
It is the tale that launched a thousand alter egos: the famous true story of “Sybil”, who endured years of torture at the hands of her sadistic mother and grew up into the meek, anxiety-ridden adult whose head was said to house 16 personalities. Luckily, with the help of her psychiatrist’s enduring dedication to her treatment – which included many punched-out office windows and late-night house calls – Sybil was finally able to come to terms with the other sides of herself and integrate them, triumphing over her disease. The tale made for a compelling book, Broadway show and an even more engaging movie in 1976 (and a less riveting remake in 2007). The book and film became instant classics, not to mention teaching tools for psychology students.
But according to investigative journalist Debbie Nathan, the story of Sybil has one big problem: it’s mostly bunk.
I AM MAD, a proud member of the mad community. Of course, madness exists – it’s normal, it’s as old as mankind, and it’s in every family. But if I have a disease in my brain called “mental illness”, I want the doctors to prove it. The brain is the most complicated organ in the body, yet doctors diagnose mental illness just by looking at you, and then you are labelled for life.
I’ve been diagnosed with unipolar depression, bipolar or manic depression, dysphoric elation – whatever that’s supposed to be – and paranoia. I’ve been told that I have a chemical imbalance in my brain that shows I have a mental illness. Yet not one of these fellows even took my pulse. They did it by sitting looking at me and talking to me.
Over the last 40 years the Diagnostic and Statistical Manual of Mental Disorders – the bible of the psychiatric professions – has spawned more and more diagnostic categories, “inventing” disorders along the way and radically reducing the range of what can be construed as normal or sane. Meanwhile Big Pharma, feeding its appetite for profits and ours for drugs, has gained an ever greater hold over our mental and emotional lives, medicalising normality.