The fifth edition of the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders “is also, frankly, a disaster for children assigned behavioural disorders,” says Northwestern professor Christopher Lane, interviewed by Spiked! Lane, the author of the much-praised Shyness: How Normal Behavior Became a Sickness (Yale, 2007) explains:
It sets the threshold for such disorders far too low, as it does for many other, poorly defined conditions such as generalised anxiety disorder, with which it’s now even easier to be diagnosed and thus, by extension, medicated. GAD was lowered from requiring three of six possible symptoms to needing just one of four. The severity threshold was also cut in half (from six months to three). Similar changes to thresholds were made right across the board.
He mentions other serious problems with the Manual, recognized by authorities but included anyway. When the prestigious English medical journal Lancet criticized one particularly bad description as ”dangerously simplistic” and “flawed,” Lane says,
the APA showed that it is largely impervious to even such expert medical concern.
And it’s not as if these judgments were voices in the wilderness. Thomas Insel, director of the US National Institute of Mental Health, the world’s largest funding agency for research into mental health, asserted just two weeks before DSM-5‘s publication: ‘The weakness [of DSM-5] is its lack of validity.’ You couldn’t get a blunter assessment than that, especially from an agency that had thrown its weight and considerable budget behind earlier editions. To let the APA save face, Insel walked back some of his criticism, but it was really a case of ‘more truth than the system can bear’. Suddenly, many who’d been highly critical of the manual began implying, ‘It’s all we have, people, so it’s time to mute concern about whether it’s actually reliable and what it says is actually true’.
One doesn’t want to be too cynical, but there are powerful economic forces, like the drug companies, very happy to see the range of problems for which their products will be distributed increased as much as possible. The expanded range of symptoms for which treatment can be given will also appeal to some doctors who, working under all sorts of pressures to get through as many patients as possible, will find a quick diagnosis and obvious prescription easier than dealing with the patient. And I’m sure patients demand it as well. No one wants to feel unhappy and everyone would like a pill to make those feelings go away.
But the result isn’t good. Lane describes the effects of the expanded DSM. First,
the massive expansion of mild psychiatric disorders, with ever-lower thresholds, has taken resources and attention from the truly chronic ones. Biological psychiatry is now completely dominant in American psychiatry, and has been for several decades, but the results and reliability it promised have proven mostly elusive (the current success rate stands at three per cent of all defined mental disorders).
Rather than expanding their focus, to address environment factors and patient testament, researchers are now doubling-down on the need to pursue ‘biomarkers’ even more exclusively. Drug regimens also come with a litany of side effects, many of them serious, so it matters greatly that people do not receive treatments they don’t in fact need.
That’s why the stakes are high. The DSM isn’t just an interesting map, as Simon Wessely [a professor psychiatry at the University of London] put it most inaccurately, as if it were purely descriptive, its effects broadly theoretical; it’s also a legal document facilitating the medication of millions, often after just minutes of consultation. It’s also a manual that’s highly prescriptive in its adjustment of norms and shrinking of normalcy — witness the new possibility to diagnosis depression among mourners after just 14 days.