I served as an advisor to two committees for the current edition and was appalled by how unscientific was the process of deciding, in essence, who is normal and what are the varieties of "abnormality" or "mental disorder." As an insider, I saw in spine-chilling detail the ways that poor science was used when it suited those in charge and the ways that good research was distorted, ignored, or even lied about when that suited them. This wouldn't matter so much, were it not for the vast suffering that being psychiatrically labeled has occasioned for so many. (psychdiagnosis.net) And yes, getting a label gets your insurance to pay for your therapy, but we should find a way to make it possible to get therapy paid for without having to label all suffering people mentally ill. There are ways to do that, and perhaps I will write about that in the future, but that will not change any time soon.

Back in 1985, when I attended my first DSM meeting, the editors were considering a proposal called Paraphilic Coercive Disorder or Paraphilic Rapism. It amounted to this: If you had committed rape and had thought a lot about it, you qualified for this label. It would, of course, be an automatic mitigating factor in trials of rapists. "Yes, Your Honor," says the rapist, "I committed that assault, but you see, I'm mentally ill. Look at the DSM-5, and you'll see that the fact that I committed the rape proves that I am. So give me a lighter sentence."

You might wonder if that could be a good thing, ensuring psychotherapy for rapists, but (1) a mitigating factor, if accepted, can lead to reduction of a sentence but does not necessarily lead to particular orders, such as for psychotherapy, and (2) even if it did, it is sad to say that no one has yet found a way through therapy to stop people from committing sexual assault.

When that category was proposed in 1985, a highly placed person in the office of the United States Attorney General sent a letter to say that if that category were placed in the next DSM, they would file lawsuits. [1] The category was withdrawn. Guess what: It's back, proposed for DSM-5. When will they ever learn? And where is the AG now?

My experience is that non-therapists are often quick to spot the reasons for alarm about much in the mental health system. If any of the above worries you, please consider going to dsm5.org and sending the authors your comments. But your comments will be far more likely to have an impact if you send your comments to all and sundry – your friends, neighbors, family, colleagues at work, editors of newspapers, anyone you can think of. And note that “org” at the end of the website, which is misleading, in that the DSM is a multi-million-dollar business for its publisher, the American Psychiatric Association, which is a massive lobby group, so the web address ought to end with “com”.

[1] Paula J. Caplan. (1995). They Say You’re Crazy: How the World’s Most Powerful Psychiatrists Decide Who’s Normal. Addison-Wesley.