Psychiatrists are finishing up the DSM-V, the latest version of the psychiatric diagnostic manual utilized by psychiatrists, therapists, physicians and insurance companies for labeling people with psychological disorders.
The manual relies on the medical model, which means it accepts uncritically the premise that everything you think or feel is, at some point, considered by medical science to be a medical disease.
The problem is that there usually is no evidence for accepting such a premise. There are no blood tests, DNA tests, X-rays or anything equivalent for establishing that there is such a thing as this or that ‘disorder.’
This leads to some rather absurd entanglements when it comes time to approve or ‘vote’ on the final version of the manual.
For example, the new diagnosis of ‘mixed anxiety depressive disorder’ was dropped. Why? Because enough people who didn’t like the disorder complained about it.
Obviously, there are instances when people get highly depressed. There are also instances when people get highly anxious, even to the point of having anxiety attacks. Any therapist will tell you that there are just as many cases where people are experiencing a combination of anxiety and depressive moods. Hence, the hybrid diagnosis.
Why all the controversy?
The New York Times online reports:
The criticism of ‘mixed anxiety depressive disorder’ was that it would unnecessarily tag millions of moderately neurotic people with a psychiatric label. Mixed states of depression and anxiety can be severe, but the proposed hybrid had looser criteria than either depression or anxiety on its own — lowering the bar significantly for a diagnosis.
‘Lowering the bar’ for a diagnosis? Make it easier for someone to be labeled with a psychiatric diagnosis? That ship has sailed!
When you study psychology in college or graduate school, the first thing they tell you is, ‘Don’t start labeling your friends and relatives with diagnoses. It’s normal and natural to think everyone you know has one of these diagnoses.’
It’s true. Why? Because so many of the labels in the psychological disorder categories are so broad, so general, and usually so based on subjective reporting, that they could in fact apply to more people than not. A glaring example of this is “attention deficit hyperactivity disorder,” ADHD for short. I once talked to a woman who was in shock. “I just found out all three of my boys have ADHD,” she said. You would think that all three boys had just been diagnosed with cancer. She was absolutely devastated. But what boy, especially in our mediocre and unmanageable public school system, doesn’t have ADHD? The vast majority fit the label. The label works well for teachers and psychiatrists, but this doesn’t necessarily make it scientifically valid. So too with much else of what passes for science in psychiatry.
Who, for example, isn’t depressed? Or anxious? At least at times? These ‘symptoms’ of ‘disorder’ tend to be relative. If you’ve spent most of your life pretty happy, and you suddenly start to feel even a little bit listless or withdrawn, then so far as you’re concerned, you must be clinically depressed. But then talk to the person who has had more ‘symptoms’ of depression for decades than you could ever dream of having. To that person, your depression is quite ‘normal’ and reasonable. This is what I mean when I say it’s all relative. To say something is relative is not to necessarily say it doesn’t exist. But it’s not medical science, either.
Another diagnosis, new to the proposed DSM-V, is ‘attenuated psychosis syndrome.’ It was criticized because some people believed it would lead to unwarranted drug treatment of youngsters.
Talk to anyone whose teenager had emotional problems, or even attempted suicide. If the teenager wasn’t on medication, the medical and psychiatric professionals will be blamed for not treating the problem with medication. If the teenager was on medication, then the medication will be blamed for the problems. There’s no winning.
Everybody approaches emotional problems in teenagers as if they’re medical illness, residing outside the mind, ideas, thoughts, emotions or behaviors of the suffering teenager him- or herself. The end result is that you look for the external ‘fix’ to mandate a cure. Some say medication is the answer, and some say it’s the problem. Each side assumes something external is required to fix the teen. Nobody seems to ask, ‘How can the teenager be guided to help fix himself?’
This is the medical model at work. Yet the teen never gets fixed, because it does not and cannot work that way. If he does ultimately improve it’s because he fixes himself, or just somehow gets through it. I challenge you to find one person who had a good experience with the mental health establishment during his teen years. I don’t doubt there is one out there, but in my twenty-five years of practice I have yet to encounter one.
How do psychiatrists establish the objective existence of various psychological diseases and disorders? Two methods are used: Reliability and ‘public commentary.’
Reliability refers to agreement among psychiatrists. If a majority says it’s true, then it’s true. Public commentary basically refers to a focus group. This is what passes for scientific diagnosis.
I know I’m expressing the unthinkable here. I’m suggesting that maybe the whole foundation upon which psychiatry and psychology as we know it rests—the medical model—is largely a sham.
But facts cannot be evaded. The entire DSM diagnostic system, which insurance companies, government and lay people all assume is as medical and scientific as medicine itself, boils down to majority vote among psychiatrists and focus groups of concerned citizens.
People need to know this. The curtain is down, and the Wizard of Oz has been exposed as something less than you thought he was.
The real truth, to some, is too difficult to face. The fact that we’re all responsible for our mental and emotional well-being is not something to be stated in polite company.
Can’t someone help you? Of course. Must you go through everything alone? Of course not. A good therapist could help you, or somebody else could help you too. People do get helped by mental health professionals, at least sometimes. But it’s not medicine they’re getting. It’s listening, humane concern, and perhaps even a new idea or two. Guidance and direction is what helps. Research has shown that people do better with medication and good therapy than with medication alone, in most cases.
There’s really no such thing as ‘treatment.’ A professional helper cannot externally take charge of your consciousness and ‘make’ you feel all better. Conventional medicine (for the body) does something to you, through medication or surgery. You sit back and let the treatment be ‘done to’ you.
It doesn’t work that way, not with emotional or behavioral problems. Even when psychiatric medication is helping—which isn’t as often as people think—it’s helping you swim with the current of life’s challenges rather than against them. But you still have to swim.
Hence the absurdity, every few years, of observing a new DSM be released, subject to public approval, majority vote and focus groups. And politics too, of course.
Let’s not forget third-party funding. Now that government will soon be the primary payer of all health care, thanks to ObamaCare, you can see the politics ahead when it comes to future DSM manuals.
When it comes to these periodic disputes over what does or does not constitute ‘mental disorder,’ you ain’t seen nuthin’ yet. It might take an act of Congress to pass the DSM-VI. The people who hold office in Washington might be the ones who make the final determination of what does or does not constitute ‘mental disorder.’ If that isn’t depressing, and downright frightening, I don’t know what is.
Psychology is a valid discipline—a young one, but valid. Psychiatry and the DSM-V leave a lot to be desired. Call it science all you want. This isn’t how science works.
Source: NewYorkTimes.com, 5/8/12, ‘Psychiatry Manual Drafters Back Down on Diagnoses.’