Friday, 16 April 2010

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.
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, 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…


PT Barnum said...

DSM is the standard international diagnostic tool for psychiatry and changes to it have direct effects on people in the UK. It operates as a checklist for mental health professionals where, if a patient scores (usually) 6 out of 10 or 5 out of 9 of the criteria, they are labelled.

There are two ways in which it can cause real damage. Firstly (as pointed out here) it pathologises ordinary human emotion and behaviour, bringing them into the Pharma fold. Secondly, there has been an ever greater tendency in DSM3 to DSM4 and now DSM5 to move towards 'disorders' which are defined as untreatable. This allows mental health services to refuse treatment to those in genuine need.

The consequences for society can be dangerous as it licences state interference in the lives of individuals whose behaviour is deemed inappropriate while abandoning those whose needs are real.

Chuckles said...

The DSM serves very little purpose other than as a checklist for the medical profession to

a) Decide whether they are going to treat something.
b) What code to use to get their money for so doing.

Typical output of a committee

Kevin B said...

Have they managed to get 'being a conservative' in there yet? I know the lefty academics in the US are always writing papers proving that not being a socialist is a mental illness.

English Viking said...

Does a pathological hatred of Manchester Utd count?

If so, can I have some Disability Allowance please?

Chuckles said...

Kevin B, I know they got as far as 'proving' that those of a leftish persuasion have higher IQ's than those of the right.
But then they had a bit of a setback when it was also 'proved' that conservatives were far more charitable, particularly with their own money, and that in matters of ethics and integrity, leftists outdid the Vogons.
So maybe this is the start of the 'fallback and regroup'?

JuliaM said...

"...there has been an ever greater tendency in DSM3 to DSM4 and now DSM5 to move towards 'disorders' which are defined as untreatable. This allows mental health services to refuse treatment to those in genuine need."

Once again, everything devolcves to cost in the end. We truly are becoming the xsociety that knows the cost of everything, and the value of nothing...

"Have they managed to get 'being a conservative' in there yet? "

I expect they are working on it!

"So maybe this is the start of the 'fallback and regroup'?"

Hmm, could be. Perhaps if they stopped thinking of humans as 'groups'..?

Nah. Never happen.