I'm one of many working in the mental health realm who's keeping tabs on the revisions of the Diagnostic and Statistical Manual of Mental Disorders, the book that quite literally defines what is and isn't mental illness. Psychologist Gary Greenberg wrote an article for this month's Wired magazine examining the revision process of what will be called DSM-5. Greenberg, appropriately given his stance as the author of Manufacturing Depression, looks at what industries have to gain from adding or subtracting mental disorders to or from the canon.
By industries, I mean the two industries most entrenched in profiting from our problems: mental health professionals, who often get paid only by giving diagnoses, and the pharmaceutical industry, which gets to create new products for every newly defined problem.
Greenberg's Wired piece forced me to ask myself a number of questions about the assumptions underlying the application of scientific process to what can be a fairly subjective endeavor. In my own master's training not so long ago, I can easily recall the anxiety felt as we tried to fit people into categories, and use those categories to determine courses of treatment.
For mental health professionals, the definitions provided by the DSM are linked to a set of actions. Without a name for it, without a diagnosis, a person who's happy, highly energetic, and impulsive might be fun. But giving the name of this constellation of symptoms "bipolar disorder, manic episode" spurs an entirely different way of thinking, and an entirely different set of actions. It means that person is at risk for things that "fun" people aren't.
Thinking about the implications for suicide prevention, we know that many people who die by suicide have a mental illness. Some, though not all, of those people were in treatment prior to their suicide. From a suicide prevention perspective, I, oddly, see a potential up-side to increasing the number of people diagnosed with mental illness.
One very popular suicide prevention strategy is to get people who are in need of treatment into treatment with a mental health provider. If more people are in treatment, and if providers know how to help people who are suicidal, more suicides can be prevented.
I'm wrestling with this idea. Part of me sees it as pathologizing people in order to help them, and I don't know about it. What do you think? What pieces am I missing?
If you're interested in reading more about DSM-5 on a Psychology Today blog, click over to Dr. Allen Frances' DSM5 in Distress.
Copyright 2011 Elana Premack Sandler, All Rights Reserved
