The Diagnostic & Statistical Manual (DSM), published by the American Psychological Association, is widely accepted as the bible for mental health descriptions and conditions. The book has been updated several times over the years, and is slated for it’s next update in 2013. If you have never seen the DSM before (and it’s likely you haven’t), you might be surprised at the depth and breadth of the number of “disorders” presented, and if you look close enough you might even find that you fit the criteria of one of them. In fact, critics have argued that the DSM has become too liberal with identifying “new” disorders, as well as loosening the criteria needed to “qualify” for a disorder.
Mental Illness
So, what is mental illness, anyway? Interestingly, there are many different ways to examine mental illness, and to some extent, what one person might see as “mentally ill” the next person might see as “quirky,” “creative,” or just “different.” In fact, it is from this perspective that some are wondering if the DSM is becoming so loose in its defining mental illnesses that nearly everyone could be diagnosed with something — leaving conspiracy theorists to surmise that once these “disorders” are labeled, pharmaceutical companies end up being the true winners as the manufacturers of the drugs that psychiatrists recommend their patients use to address their problems.
If you were to develop a continuum of people ranging from those who seem relatively healthy and stable on one side, to those with clear mental problems/limitations (i.e. of harm to oneself or others) on the other, it’s actually all the people in the middle who are the ones that seem to be of the greatest interest to mental health professionals. Who is “normal” versus “abnormal?” And who needs to be “put on something” versus who might benefit from just a couple lifestyle changes and possibly therapy? It is here where the debates rage, and where the DSM (and it’s ever-changing criteria) end up having real consequences for real people.
Having taught clinical psychology at the college level, it has always been an entertaining classroom discussion to hear students ponder over what’s normal, abnormal, quirky, odd, and different — as well as what people should be diagnosed with something, and what people should be put on something. As the DSM evolves and spells out “disorders” for clinicians, decisions are made that in many cases lead to the prescription of one (or many) medications – some that include serious side effect concerns. The other problems that often occur when a person is diagnosed with a mental illness are the following:
- Patients often overly-value the benefits of their new medication, and as a result place less emphasis on behavioral changes (after all, only the drug can fix their problems, right?)
- Patients often believe they are permanently “branded” with the mental disorder for the rest of their life (and therefore need to continue on using their medications forever). Of course, in some cases medications may be needed to protect the patient from danger to himself (or others), but in many other cases positive changes occur in the patient’s life, leaving him less needy of the drug (i.e. he is no longer depressed).
The Impact of the DSM, Treatment Decisions, and Future Consequences
Unfortunately, for potential clients in the United States today seeking therapy they will likely need a DSM mental disorder code in order for their insurer to reimburse. This is unfortunate for a number of reasons, including the fact that a disorder needs to be “found” – which often leads to an even bigger problem of a self-fulfilling prophecy. For example, the person seeking assistance after going through a tough divorce may come to believe that she is depressed – and depression lasts for a lifetime – and the only way to control the depression is by taking several different pills each day. Without a DSM diagnosis, the odds of an insurance company helping out a patient who is simply going through a tough time in life is almost zero. Sadly, once a patient receives her diagnosis, it often only serves as a really bad lifelong tattoo, re-emerging during times like when the individual applies for future life and/or health insurance (she will now be a “high-risk,” and pay a ton more for her coverage).
Getting back to the original discussion, it’s interesting to see what the new DSM will evolve into in 2013. If, as critics warn, the diagnoses become even more liberal (you should read some of the criteria to see what I am referring to), more people will soon learn they have “something,” and likely will feel the immediate need to remedy and temper their condition by quickly going on some kind of drug(s). Skeptics wonder if it will be this new disorder discovery, coupled by the new drugs these patients take, that end up causing the real problems — and not the initial concern for the call to the doctor. Interesting to think about, isn’t it?
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