‘Psychiatric bible’ is not quite fact

In Opinion

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has come under much scrutiny from respected publications, the psychiatric community, and even associates of former versions of the DSM.

The DSM, published by the American Psychiatric Association (APA), is responsible for setting the standard for classifying mental disorders. Nicknamed the “psychiatric bible,” it is all but fitting, for the DSM has both consciously and consistently employed an overly literal sense of interpretation that is often accepted far too often as fact.

Not only has the DSM been utilized for such misguidance, it has been proved to be culturally biased as well, labeling anything outside of Euro-American concepts to be “culturally bound,” backhandedly stating that the norm for diagnosis rests within the hands of Western definitions.

While the DSM has no doubt aided people, there are many places within the DSM that are spotty at best, and some changes in DSM-5 are a prime examples.

Dr. Darrel Regier, M.D., was quoted as saying that the DSM-5 is “a set of scientific hypotheses that are intended to be tested and disproved if the evidence isn’t found to support them.”

He also continued to say that it has also not been tested as well as they would like, and that the plan is for immediate testing to be enforced after the DSM is official.

This is not how a manual that is constantly being referred to as the standard of psychiatric disorders should be treated. The DSM-5 is not meant to be a symbolic lab rat experiment, nor is it a place for little evidence to be put forth as “fact.” Surely more proof can be put into such a system before it is implemented, and such a casual outlook should not be tolerated.

The implications of the DSM-5 seem to further undermine those who deserve treatment for real conflicting disorders while simultaneously overstating other reactions as much too subversive. Much of the attention drawn to the DSM-5 has revolved around Asperger syndrome, depression, and gender disorder.

In the DSM-5’s most controversial decision, Asperger’s has been removed and placed within Autism Spectrum Disorder instead. Although some with Asperger’s are accepting of the change—the categorization may add a larger degree of significance towards their struggle—the DSM-5 seems to only further stigmatize those who have it and disregards the unique situations that those with Asperger’s are faced with.

Although many symptoms of Asperger’s cross over into the Autism Spectrum Disorder, it is important that we empathize with the various degrees in which they differ as well. If the DSM is to be a place of reference, then broadening the spectrum should be a priority, not closing it.

Another controversial element of the DSM-5 includes turning normal grief into a Major Depressive Disorder. Although the difference can be interpreted by a psychiatrist or by the patients themselves, the wordy explanations only further pathologizes a natural human emotion. Although bereavement does have the possibility of turning into something more severe, the DSM disregards individual situations and is trying to standardize what emotion is.

One element of the DSM-5 that might be considered a “win,” especially among proponents of LGBT rights, is changing “gender identity disorder” into “gender dysphoria,” however, political correctness isn’t a cause for celebration.

Gender has no place within the DSM as it is entirely culturally bound. Historical non-Western beliefs such as two-spirits, hijras and various other dual gender standpoints are pushed aside since their downfall via coercion of Western mentality. When “homosexuality” was deemed to be inappropriate by the DSM many years ago, it was removed, not given a new name. Gender “disorders” come with a significant amount of mental stress, but part of that blame can rest on society, which continues to disregard the needs of such people.

Altogether, it is not to say that the DSM is completely flawed, and it has surely had its significance within the psychiatric community. A complete rejection of the DSM-5 is not exactly logical either as insurance companies and clinicians everywhere will still be relying on the text so they can decide upon treatments for individuals. What can be said about the DSM-5 is that it appears that more research can go into it.

Ultimately, it is also up to individuals and close ones to help in any sort of mental assessments. The DSM-5 should simply act as a supplement, not the defining text of our mental health.

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  • Anthony

    There is nothing new in this; since DSM-3 the DSM has worked on the principle of ‘operationalised diagnosis’, i.e. diagnosis in terms of symptom clusters detatched from any concrete pathology. The standardised questioning and diagnostic criteria are designed to force different psychiatrists into identical diagnoses, in order to convey an appearance that the diseases are real. As the constant change in diagnostic categories since then has shown, this appearance is an illusion. Psychiatry operates by creating this secondary layer of labelled illnesses which it diagnoses and treats, but it has no real understanding of what is actually going wrong with the individual patient. The beginnings of this process are well described in the book ‘Selling the DSM, the rhetoric of science in psychiatry’.

  • Lisa Bowen

    Garrett — The American Psychological Association does not published the DSM. The American Psychiatric Association publishes the DSM. Please make the correction to your article.
    Thank you,
    Lisa Bowen
    Public Affairs Director
    American Psychological Association

  • sydney stevens

    what is the volume and issue number of the paper on dec.10, 2012?

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