How Psychiatry Went Crazy

The Diagnostic and Statistical Manual of Mental Disorders is often called the “Bible” of psychiatric diagnosis, and the term is apt. The DSM consists of instructions from on high; readers usually disagree in their interpretations of the text; and believing it is an act of faith.

The DSM-II (1968) made homosexuality a mental disorder, a decision revoked by vote in 1973‚ĶNarcissistic Personality Disorder was voted out in 1968 and voted back in 1980; where did it go for 12 years? Doctors don’t vote on whether pneumonia is a disease.

The new DSM-5, with its modernized Arabic number, is 947 pages. It contains, along with serious mental illnesses, “binge-eating disorder” (whose symptoms include “eating when not feeling physically hungry”), “caffeine intoxication,” “parent-child relational problem” and my favorite, “antidepressant discontinuation syndrome.” Now psychiatrists can treat the symptoms of going off antidepressants, which is good because the expanded criteria for many disorders allows doctors to prescribe antidepressants more often for more problems. Gone is the “bereavement exemption,” for example. You used to get two weeks after a loved one died before you could be diagnosed with major depression and medicated. Now you get two minutes.

More at the WSJ.

Comments (14)

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  1. JD says:

    scary stuff. what couldn’t be classified as a mental disorder? then, how long until they decide that you are unfit to make decisions on your own?

  2. Ryan says:

    I agree with this article. It’s pretty ridiculous how all of these “disorders” are becoming increasingly acceptable and prevalent ways of “treatment.” I can easily go to a doctor and tell him I feel sad and get on anti-depressants when I may not really be depressed. The same goes with ADD and a host of other “disorders.” Where do we draw the line?

  3. Ron says:

    Sometimes I eat when I am not really hungry. I guess I need to go and get treated for binge-eating disorder. I certainly need more prescription drugs in my body.

  4. August says:

    Looks like the DSM-5 giving doctors more leeway to act. It now depends on psychiatrists to use it judiciously.

  5. Studebaker says:

    I guess I should buy a copy on Amazon and read it to see if I’m crazy! I wasn’t according to the last edition; but maybe I am according to the new DSM-5!

    I wonder if worrying about whether the new edition of the Psych Bible turned one of my personality traits into a mental disorder is classified as a mental condition requiring counseling? It’s probably listed under DSM-5 paranoia.

  6. JD says:

    The issue really comes down to choice. Do we make decisions that shape our lives or are we insurmountable naturally inclined behave certain ways. It sounds like psychiatrists are saying the latter, that they can engineer a human to perfection and alleviate choice.

  7. Baker says:

    The influence of the self-interest:

    “Faced with a looming deadline and terrible data, Mr. Greenberg suggests, the DSM directors did what any reasonable, self-protecting institution would do: They lowered the statistical criteria for acceptable standards of reliability and turned defeat into victory. “

  8. William Jones says:

    Interesting post. Psychiatrist certainly do take liberties with defining mental diseases. I definitely agree that some disorders are ridiculous by the sheer fact of what they are (binge-eating, Narcissism, caffeine intoxication), but there are 946 pages of disorders would should take some of them seriously.

  9. Nigel Molesworth says:

    Doctors don’t vote on whether not or pneumonia is a disease now, because we have had decades of studying it, whereas Psychiatry/human psychology has not had as much time to develop concrete scientific argument (it is still a new science).

  10. John Craeten says:

    Homosexuality could be a mental disorder. Not much modern research has been done on the topic, because obviously calling a minority view a mental disorder is not exactly politically correct in contemporary society.

  11. Patel says:

    Mental disorders are hard to measure, in part because the our brains are alot more complex to study and understand than our liver. Add to this, our technology is still not advanced enough to make way for the various conditions going inside our head.

  12. JD says:

    @John Craeten

    I disagree. “Calling a minority view a mental disorder” is politically correct. Some minorities are in vogue, others are despised. The danger is precisely that the majority decides that one group is wrong (ailed by a mental disorder) and decides to correct it. This is very, very dangerous.

  13. John L says:

    My own take is that it’s not especially significant for treatment margins, though it is disquieting. Unlike more traditional medicine, psychiatry is more symptom-driven than diagnosis-driven, and many of the more traditional psychiatric ailments (e.g. depression, anxiety) typically manifest themselves with these other “new” diagnoses. For instance, “binge eating” is typically associated with depression, and it would still be treated with the same medications that would be used for the new disorder. Behavioral health managed care companies have indicated that 80%+ of their claims are depression-related, and that is unlikely to change just because your tendency to eat a whole box of donuts is now recognized in its own right.

  14. Henry says:

    Patel: brains aren’t as complex as you might think. Some are from Mars and some are from Venus!! :)