Comments on the fourth edition of the bible of the mind biz--the
'Diagnostic and Statistical Manual of Mental Disroders' (DSM-IV) now in
press. The manual establishes criteria that are used to diagnose the
distressed. Comment by Mark A. Hubble, Ph.D.; What critics say about the
DSM-IV; Comment by Mitchell Wilson, M.D., in the 'American Journal of
Psychiatry' (Vol. 150, No. 3); How to make sense of psychiatry's
diagnostic swelling.
By
PT Staff, published on November 01, 1993
Psychiatric Diagnosis
People have always had a need to categorize the human experience.
Now psychiatrists are taking labeling to a whole new level with the
fourth edition of the bible of the mind biz--the Diagnostic and
Statistical Manual of Mental Disorders (DSM-IV).
Now in press, the manual establishes criteria that psychiatrists,
psychologists, and mental-health workers of all persuasions use to
diagnose the distressed. Culled from the most current thinking and
research, DSM-IV continues the classification mania set in motion in 1952
with the debut of the original DSM.
"It's been a road to hell paved with expert consensus," insists
psychologist Mark A. Hubble, Ph.D., who sees DSM-IV as a fashion catalog
of "what's in and what's out" in the murky world of the mind. He and
other observers contend that the DSM-IV:
o fails to reflect fully the enormous influence of culture,
ethnicity, and economic status in producing mental disorders--and in the
conferring of diagnoses. Studies show, for example, that the wealthy get
more benign diagnoses while the poor are usually classified as more
seriously ill.
o consistently encourages stereotyped, catch-all labels, rather
than in depth understanding of each person's unique situation. "When you
hear the dreaded word 'borderline,' you get a set of images" that may or
may not wholly accurate for you, Hubble says.
o often becomes a political document. Until dropped from the DSM in
1973, for example, homosexuality was classed as a disease. The switch
demonstrated that deviance is as much constructed by social agreement as
suggested by scientific evidence.
o ignores lessons learned from family therapy about real people
living in a social context. "People are embedded in a whole group of
relationships" that determine who they are, says Hubble. What's more,
reports psychiatrist Mitchell Wilson, M.D., in the American Journal of
Psychiatry (Vol. 150, No. 3), DSM-IV furthers the medicalized "narrowing
of the psychiatric gaze" by teaching doctors to focus only on "the
superficial and publicly visible," and to ignore personality, development
of character, and the unconscious mind.
o fails to help clinicians develop individual psychotherapy plans
or predict the outcome of psychotherapy. Because most clinicians have
trouble keeping up with current research, they resort to doing the type
of therapy they're most comfortable with, regardless of diagnosis, says
Hubble.
How to make sense of psychiatry's diagnostic swelling? It may not
accurately reflect the nature of human problems, say Hubble and Wilson,
but it follows the widening scope of medications and the need for strict
classification codes by insurers.
ILLUSTRATION (KENT CHRISTENSEN)
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