Today, the American Psychiatric Association released the much-anticipated fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, a 1,000-page revision 20 years in the making.
The book has come under heavy fire from mental health professionals, including the National Institute of Mental Health (NIMH), which has distanced itself from the DSM-5 because of its tendency to define disorders based on symptoms, not scientific data.
Many others have come out against the book's broadening of diagnoses, including its assertion that the grief experienced after a loved one’s death can be diagnosed as major depression. Other changes include labeling children’s tantrums as “disruptive mood dysregulation disorder," and excessive thoughts about pain as “somatic symptom disorder.”
Some mental health experts say the DSM-5 is leading us down a dangerous path toward treating and medicating normal human emotional responses.
Stigmatizing the Human Experience
The current version of the DSM defines mental disorders as “serious deviations from expected cognitive, social, and emotional development.”
However, there’s much contention over what’s serious and what our expectations of behavior should be.
The U.S. Centers for Disease Control and Prevention (CDC) recently released statistics stating that an estimated one in five American children and teens has a diagnosable mental disorder, namely attention deficit hyperactivity disorder (ADHD), conduct problems, anxiety, or depression.
That’s not a very surprising statistic considering the level of emotional and social growth that occurs during a child’s school years. Anyone who remembers their time in middle school knows the stresses of balancing schoolwork, friends, and after-school activities like sports, band, or a job.
The NIMH estimates that 26.2 percent of all adults will experience some kind of mental disorder within a given year and that 46.4 percent will experience some kind of mental disorder within their lifetimes.
But if mental health diagnoses are so common, is crazy is the new normal?
“I've always preached that everyone is crazy, it's just a matter of degree, duration, and timing,” said Rob Dobrenski, a psychologist in New York City and author of Crazy: Notes On and Off the Couch. “Take a look at the current DSM—if you have a lot of time to kill. There are some incredibly benign diagnoses in there, at least one for pretty much everyone out there, myself included.”
Having Normal Human Emotions? There’s a Pill for That
Psychiatrist Allen Frances chaired the task force for the DSM-IV, but now takes an entirely different view of the psychiatric community and the DSM-5.
In his new book, Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life, he argues that normal life events are now being branded as mental disorders, while at the same time, people who desperately need help are not getting it.
He says that loose diagnoses are causing a prescription drug overdose problem, while psychoactive drugs have become “star revenue producers” for drug companies. In 2011, antipsychotics, antidepressants, and ADHD drugs accounted for $37 billion in revenue.
Given that primary care doctors who sometimes lack proper training and face intense pressure from drug salespeople write 80 percent of those prescriptions, the average seven-minute appointments create a “topsy-turvy misallocation of resources,” Frances wrote.
Frances says that differences in individuals' personalities were never meant to be reduced to a list of diagnoses and that a full palette of emotions is needed to live life to the fullest.
“The writing is on the wall. ‘Normal’ badly needs saving; sick people desperately require treatment. But DSM-5 seems to be moving in just the wrong direction, adding new diagnoses that would turn everyday anxiety, eccentricity, forgetting, and bad eating habits into mental disorders,” he wrote. “Meanwhile, the truly ill would be even more ignored as psychiatry expanded its boundaries to include many who are better considered normal.”