DSM: A disease in itself?
How Psychiatry Went Crazy
The "bible" of psychiatric diagnosis shapes — and deforms — both treatment and policy
By CAROL TAVRIS, WSJ
The Diagnostic and Statistical Manual of Mental Disorders is often called the "Bible" of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.
At least the Bible lists only 10 Commandments; the DSM grows by leaps and bounds with every revision. The first edition, published by the American Psychiatric Association in 1952, was a spiral-bound pamphlet that described 11 categories of mental disorder, including brain syndromes, personality problems and psychotic disorders. (The final category, "Nondiagnostic Terms for the Hospital Record," contained Dead on Admission, the one diagnosis that psychiatrists have ever agreed on.) The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973. In the general excitement about that progressive decision, few noted that voting didn't seem to be the most scientific way of determining mental illness. Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don't vote on whether pneumonia is a disease.
The DSM-III (1980) was an effort to jettison outdated theories and terms such as "neurosis" and replace them with an objective list of disorders with agreed-upon symptoms. The DSM-IIIR (1987) was 567 pages and included nearly 300 disorders. The DSM-IV (1994, slightly revised in 2000) was 900 pages and contained nearly 400 disorders. The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, "binge-eating disorder" (whose symptoms include "eating when not feeling physically hungry"), "caffeine intoxication," "parent-child relational problem" and my favorite, "antidepressant discontinuation syndrome." Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the "bereavement exemption," for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.
(More here.)
By CAROL TAVRIS, WSJ
The Diagnostic and Statistical Manual of Mental Disorders is often called the "Bible" of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.
At least the Bible lists only 10 Commandments; the DSM grows by leaps and bounds with every revision. The first edition, published by the American Psychiatric Association in 1952, was a spiral-bound pamphlet that described 11 categories of mental disorder, including brain syndromes, personality problems and psychotic disorders. (The final category, "Nondiagnostic Terms for the Hospital Record," contained Dead on Admission, the one diagnosis that psychiatrists have ever agreed on.) The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973. In the general excitement about that progressive decision, few noted that voting didn't seem to be the most scientific way of determining mental illness. Narcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don't vote on whether pneumonia is a disease.
The DSM-III (1980) was an effort to jettison outdated theories and terms such as "neurosis" and replace them with an objective list of disorders with agreed-upon symptoms. The DSM-IIIR (1987) was 567 pages and included nearly 300 disorders. The DSM-IV (1994, slightly revised in 2000) was 900 pages and contained nearly 400 disorders. The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, "binge-eating disorder" (whose symptoms include "eating when not feeling physically hungry"), "caffeine intoxication," "parent-child relational problem" and my favorite, "antidepressant discontinuation syndrome." Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the "bereavement exemption," for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.
(More here.)
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