You Don’t Have To Be Mad To Work Here Be In This Book…

Where exactly does the difference lie between extreme human behaviour and a psychiatric illness? The question is being asked because as a US encyclopaedia of psychiatry is rewritten for the first time in more than a decade, controversy is already raging about what goes into it, and what gets thrown out.

Because you can see what’s going to happen already, can’t you?

More disorders, more medicalisation of normal human behaviour, more ‘he’s not bad, he’s mad’ excuses….

Critics say that the revised edition of the Diagnostic and Statistical Manual of Mental Disorders (or DSM, as it is commonly known) will lead to an explosion of healthy Americans being prescribed powerful drugs. Patients' rights groups are angry that it will lead to more people being stigmatised as mentally ill.

"The conditions that we grew up thinking were in the normal spectrum of human behaviour – sadness, disappointment, anger – are now considered a psychiatric or psychological disorder. It has become part of a national epidemic," said Alex Beam, a newspaper columnist and author of Gracefully Insane, a book about the history of McLean psychiatric hospital in Massachusetts.

Quite.

Proposed additions to this, the fifth edition of the manual, include: "hypersexual disorder" for those experiencing severe problems with sexual fantasies, urges or behaviours; "temper dysregulation with dysphoria", which refers to children throwing acute temper tantrums; and "psychosis risk syndrome", a condition attributed to eccentric or marginalised teenagers.

This is an American publication, but I bet there’s a whole host of UK educators anticipating the upgrading as a way of fending off calls to discipline badly-behaved children…

Even small changes in wording can have serious implications. If requirements for diagnosis are too stringent, some who need help will be left out. If they are too loose, healthy people will receive unnecessary, expensive and possibly harmful treatment. Dr Frances describes how his panel inadvertently contributed to three "false epidemics": attention deficit disorder, autism and childhood bipolar disorder.

All of which we’ve seen in schools…

He says: "We felt comfortable that our relatively modest proposals wouldn't cause problems, but evidence shows that our definitions were too broad and captured many 'patients' who might have been far better off never entering the mental health system."

And, naturally, created yet more ways for people to slide into the incapacity benefits culture.

Many healthcare professionals say there have not been sufficient advances in research to merit an entirely new edition. Dost Öngür, clinical director of the psychiatric disorders division at McLean Hospital, says, "We could have lived another five or seven years without a new edition." He describes the growing numbers of people diagnosed as mentally ill as part of a wider "sociological trend".

Aha! The plot thickens…

Controversially, the editors of the new edition propose creating a new, all-encompassing category which they dub "autism spectrum disorder".

High-functioning people with Asperger's disorder argue that they should not be in the same category as those with severe autism who cannot carry out basic day-to-day tasks such as dressing themselves. And the category dealing with eating disorders is likely to be expanded.

Critics say the new definition of "binge eating disorder" as one eating binge per week for three months would apply to most Americans.

And almost certainly to some of our home grown underclass…

The proposed changes have been posted on the internet, at dsm5.org, so that members of the public can comment during the public consultation period, which lasts until 20 April. In May, field trials begin and are to last for 10 months. Then we will find out which way madness lies.

Oh, no need. I already know…