I was going to drop the DSM-5 discussion last week, but another article came to light, and I just couldn’t do it. Sorry. This time its an Op-Ed piece in the New York Times, Not Diseases But Categories of Suffering.
It’s not the current A.P.A.’s fault. The fault lies with its predecessors. The D.S.M. is the offspring of odd bedfellows: the medical industry, with its focus on germs and other biochemical causes of disease, and psychoanalysis, the now-largely-discredited discipline that attributes our psychological suffering to our individual and collective history.
Actually the delusion of the APA is that the DSM will resolve this conflict, it’s revisionist editors from the very beginning have been the very people behind ‘the discrediting’, mentioned in the above paragraph, of psychoanalysis.
The American Psychiatric Association has been trying to do just that ever since, mostly by leaving behind ideas about the meaning of our suffering in favor of observation and treatment of its symptoms. In 1980, it hit on the strategy of adopting a medical rhetoric, organizing those symptoms into neat disease categories and checklists of precisely described criteria and publishing them in the hefty — and, according to its chief author, “very scientific-looking” — D.S.M.-III.
The pathologizing of human suffering, and not suffering symptomatic of any known physical disease, but rather that suffering which can be said to have arisen from emoting and thinking. Types of suffering are seen as disease manifested through a variety of symptoms.
Previously I stated that this process was a matter of normalizing medicalization, and this is so, what we’ve got here is medicine’s incursion into areas that, strictly speaking, are specifically not medical, and specifically not science.
In this Op-Ed piece we read the following, “And as any psychiatrist involved in the making of the D.S.M. will freely tell you, the disorders listed in the book are not “real diseases,” at least not like measles or hepatitis. Instead, they are useful constructs that capture the ways that people commonly suffer.” I wonder why does so much of the mental health industry rhetoric and literature insist then on stating that “mental illnesses” are real, that they are real diseases, and not only that they are real diseases, but that they are diseases of the brain. We’re stuck with an either/or that would be a both/and, but…Hey, whatever stretch you can come up to resolve that one has got to break on close examination.
My feeling has always been that this clamor is going to fizzle to a uncomfortable grumble once the volume is released in 2013. If such is the case it will be unfortunate indeed. For years now we’ve been uncomfortably enduring the fruits of the DSM-IV. Those fruits are these growing epidemics of autism, bipolar disorder, ADHD, and depression. My feeling is that as the DSM usually works by division and addition rather than subtraction (starting with 28 mental disorders, now you’ve got something like 374) the 20 % USA labeled “mentally ill” rate is likely to go up rather than down.
The DSM has been referred to as the psychiatrists’ bible. The bible is the number 1 best selling book of all time. The DSM is doing none too poorly itself.
On the other hand, given that the current edition of the D.S.M. has earned the association — which holds and tightly guards its naming rights to our pain — more than $100 million, we might want to temper our sympathy. It may not be dancing at the ball, but once every mental health worker, psychology student and forensic lawyer in the country buys the new book, it will be laughing all the way to the bank.
‘Laughing all the way to the bank’ together with drug company executives riding piggyback on this volume of sheer non-sense. The mortality gap for people in treatment labeled with psychosis is widening, not narrowing. This mortality gap is the direct result of our societies over reliance on the quick and chemical fix. The quick and chemical fix is one of the results of using this balderdash to treat people who suffer. At one time we as a nation were a lot better off where our emotional stability was concerned, and at that time there was no DSM. We could be a lot better off again if we were to chuck the present volume into the trash heap now, and call off any future revisions. The internal national enemy of a rising “mental illness” rate is not going away anytime soon as long as this book is used to alienate, marginalize, and disempower an increasingly large segment of the American populace.
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