The DSM, From Jabberwocky to Mock Turtle

I found this Opinion Piece, Why we need a manual on mental disorder, in the PostPartisan section of the Washington Post lame, amusing, as well as completely wrong headed.

The Washington Post, unlike the New York Times, has always had a less than independent warm and cozy bed fellow type of relationship with the psychiatric profession and the pharmaceutical industry. This article further reflects that relationship.

First let’s go to where it is right on target.

Critical assessments of DSM’s next edition include that it will serve as a vehicle by which to sell more drugs and that it will make health insurance more difficult to obtain. It is easier to rationalize prescribing a pharmaceutical for someone with a DSM-certified problem (“hypersexual disorder,” for example, is proposed for people who suffer from an unusually high sex drive) than for someone without, just as it is easier to justify denial of coverage to someone who appears to be headed for a lifetime of expensive monthly prescriptions than for someone whose chart is diagnosis-free. Indeed, an edition of DSM chock-full of new disorders (such as “Internet addiction”) runs the risk of “massively pathologizing people,” said Dr. Jerome C. Wakefield, a professor of social work and psychiatry at New York University.

Why do we have a DSM?

1. So that doctors and the drug industry can sell more drugs.
2. I wouldn’t say that the DSM was designed to prevent certain people from receiving health insurance. I would say that much of its existence is for health insurance purposes. Now that we have mental health insurance parity, insurance companies have to cut deals with the government, psychiatrists and drug companies in the interest of financial survival.
3. Somebody has to pay for these drugs, if the ‘patient’ can’t afford it, the doctor and the drug industry have to turn to an insurance policy, private or public, to profit from the matter.

Now let us look at the articles wrong headedness.

But the critics should realize that a definitive and authoritative reference is an essential tool for alleviating the pain and suffering of those who are afflicted. In the debates over the new edition, it’s easy to forget that treatment is the end goal of psychiatry. Sure, a DSM taken to its logical extreme would need to list 6.8 billion disorders, one for each nut on the planet. But going in the opposite direction, having fewer or inadequate guidelines to help professionals identify mental illnesses and the proper treatments for them, could be worse. The APA has a nearly impossible — yet massively important — job on its hands.

Treatment should never be the end goal of psychiatry. Such treatment is a means by which we arrive at the end goal of mental health recovery.

One essential tool for dealing with everything from caffeine and cigarette dependence to bed wetting and rebellion is common sense. When common sense goes by the wayside, you have a field guide to the species that inhabit Wonderland. Some of us feel that the DSM is much more like this field guide to the species that inhabit Wonderland than it is too any truly essential tool.

If the extreme illogic of the DSM would go so far as to lay a disease on every inhabitant of the planet, of course, the gig would be up. The DSM would be found out for exactly what it is. Individuality here is the culprit, so let’s make an illness of it, and stamp it out. By ignoring differences, and focusing on similarities, you can say we are more similar than we are different, and marked differences can be denigrated to the category of disease. Take a more scientific approach, use a magnifying glass, and those differences again resurface on a more ‘universal’ scale.

The mental illness rate has been climbing for over a century. The drugs used in the maintenance of these conditions are debilitating. So when confronted with ordinary human distress, not knowing what to do with it, we get a doctor to prescribe a drug for it, and out of that drug usage comes a further chemical disability. This process does not necessarily recover anybody to full functionality.

When you have 297 disorders listed in your manual of mental disorders, you are going in the wrong direction when you try to stuff more disorders into this manual. Especially when any minor mental disorder listed is little more than an idiosyncrasy, and there is nothing particularly pathological about idiosyncrasies.

Human is human, and there are fewer examples of humanity more human, in so far as their capacity to make errors is concerned, than those members of the psychiatric profession who are involved in the revising of the DSM. Common sense, together with the remedies nature provides, offer a much better cure than these quack pseudo-scientists ever had imagined. Nonsense, uncorrected by sense, is a permanent diversion of time.

The one thing that these doctor editors do teach us is that commonsense doesn’t always prevail.