I used to believe that to sell books, you needed catchy titles. I was wrong. I can think of few titles less catchy than Diagnostic and Statistical Manual of Mental Disorders. Even the short version, DSM, doesn’t qualify as catchy. And yet this publication of the American Psychiatric Association is a best seller, popular both at home and abroad.
Now in its fourth edition, the manual identifies some 300 dysfunctions, syndromes, addictions, phobias and the like. That’s nearly triple the number identified in the first edition, which appeared over half a century ago.
Either we’re getting crazier or psychiatrists are getting better at identifying what makes us crazy. Or maybe they’re not.
I realize that crazy isn’t a technical term. But technical terms keep changing, even when the conditions they refer to don’t. Besides, crazy is my preferred euphemism for mentally ill. When a fellow musician shouted, “Crazy, man,” after I soloed on “Lazy River,” I thanked him. If he had shouted, “Mentally ill, man,” I might have thumped him.
Whatever the terms, some specialists say that by DSM criteria nearly a third of us are mentally disordered in any given year. Others say that half of us will meet the criteria sometime in our lives. If they’re right, and the manual keeps expanding, we could soon reach the point where it’s normal to be abnormal.
Maybe the fifth edition of the DSM will reverse the trend. If not, we could eventually reach the point where it’s abnormal to be normal.
I wouldn’t bet on a reversal. Betting is gambling and the DSM includes pathological gambling as an impulse control disorder. So don’t hold your breath waiting for a retreat. For all I know, pathological breath holding may be waiting for inclusion.
Making it into the DSM can do wonders for an aspiring disorder. Psychiatrists are more likely to diagnose it and pharmaceutical companies to provide drugs to treat it. Why, near epidemics of ADHD, autism and bipolar disorder broke out after the fourth edition of the DSM merely changed how it defined them. Diagnostic surges mean big money for psychiatrists and drug companies. Patients gain a lot, too, including stigma, financial stress, and side effects.
Getting into the DSM isn’t easy. But if appeals to medical science falter, champions of a disorder may resort to political science. That’s what happened with post-traumatic stress disorder. Propelled by heavy lobbying, it made the DSM’s third edition.
Some diagnoses, like binge eating disorder, get into the DSM’s appendix, where they await further scrutiny. The hope is that they’ll eventually proceed to the main manual as full-fledged mental illnesses. Spurned diagnoses, like compulsive shopping disorder and exercise addiction, bide their time.
Not only is the DSM a best selling book, but anti-psychotics and antidepressants are best selling drugs. Oh, I know that correlation is not causation. But if the DSM keeps growing, don’t be surprised to see us all on mind, mood,or behaviour-altering prescriptions. I wouldn’t expect it to happen randomly. At least in part, it might happen chivalrously: women and children first. But if it does happen, the DSM could classify a new diagnosis: universal pharmaceutical consumption disorder. I can’t wait to see what doctors might prescribe for it.
A prescription like that may sound paradoxical. But drugs routinely counteract each other’s side effects. So I’m confident pharmaceutical companies are up to the challenge. Since drug therapy superseded talk therapy in psychiatric treatment, they’ve shown they can work wonders. That is, they can invent pills on demand for our burgeoning disorders. Or is it disorders on demand for their burgeoning pills?
Attempts at curbing the diagnostic epidemic could face determined opposition. To avoid spooking psychiatrists, I propose a gradual approach. First, target disorders languishing in the DSM’s appendix. An appendectomy might clear the way for more radical surgery. But don’t be shy in proposing surgical intervention. Shyness can be a social anxiety disorder. Succumb to it and you could be diagnosed into submission. Triumph over it and you might win a round for diversity. That is, you might prevent doctors from medicalizing idiosyncrasies.
Making it out of the DSM can also do wonders for a disorder. With lobbying, not to mention bullying, homosexual activists got their disorder removed and turned into a right. Transgender activists hope to have theirs removed as well.
Having exited the DSM, homosexual activists appear intent on having their opponents enter it. Otherwise, why tag them with a phobia? It would be a major coup if homophobia replaced homosexuality in the popular manual. Science couldn’t be more political than that.