The upcoming 5th edition of the DSM is problematic for a number of reasons, most notably that the revisions has done away with the multi-axial diagnostic system, and taken an even greater step in the direction of medicalization of mental illness. I find myself critical in questioning many facets of the psychiatric paradigm at a time when I regularly teach Abnormal Psychology to fresh faced and eager undergraduate psychology students. In the wake of more recent research suggesting that about half of those incarcerated for crimes in the U.S. show signs of mental illness (see Kristof, 2014), I can’t help but wonder: is our psychiatric system broken?
Perhaps a more apt question is not whether or not it is broken, but alas, how broken is the current diagnostic system and treatment for the mentally ill in our country? The following facts do not bode well for our system, if one were to look not only at how inadequate treatment is for the mentally ill, but also how little access there is for mental health services for those who need it the most.
For instance, as one of the most vocal opponents of the upcoming 5th edition of the DSM, fellow PT blogger, Dr. Frances, writes about how much of a “pill popping” culture we have become in turning to meds as relief for mental illness. Moreover, he goes on to identify the startling paradox that, “Perhaps half the people taking psychiatric medicines don't need them, while more than half the people who do need them are not taking them. Symptoms that are severe and persistent should be an immediate call to diagnosis and treatment. Symptoms that are mild and in reaction to a life stress will usually go away on their own” (Frances, 2013, para 8). Unfortunately, many patients with relatively mild symptoms who are dealing with regular life stressors are oftentimes medicated after only a “brief diagnostic evaluation” while those with more severe or problematic symptoms who may benefit the most from meds and therapy are not getting the proper treatment for a number of reasons (Frances, 2013).
Thus we have the damning fact that the mentally ill are being criminalized, with “more than three times as many mentally ill people housed in prisons and jails as in hospitals” (Kristof, 2014, para 9). The stigma of mental illness continues to persist, with the mentally ill who are incarcerated oftentimes being targets because of their illnesses.
In fact, mental illness stigma is so pronounced that even physicians show signs of stereotyping when treating their patients. For instance, Garey (2013) reports that:
At least 14 studies have shown that patients with a serious mental illness receive worse medical care than ‘normal’ people. Last year the World Health Organization called the stigma and discrimination endured by people with mental health conditions ‘a hidden human rights emergency’ (para 5).
In fact, Garey (2013) goes on to cite startling research that finds people who are mentally ill and use the health care system are likely to die 25 years earlier than those who are not mentally ill. I wonder what changes need to be implemented to reverse these negative effects, so that we can go back to a diagnostic system that offers help and meaningful treatment for those suffering from mental illness. Indeed, if a society is to be judged by how it treats its most vulnerable members, we have a lot of work to do as a culture, particularly for those of us in the field of mental illness and education.
Frances, A. (2013). Back to Normal. Psychology Today Blogs: DSM V in Distress. Retrieved on February 9, 2014 from: http://www.psychologytoday.com/blog/dsm5-in-distress/201307/back-normal .
Garey, J. (2013). When Doctors Discriminate. The New York Times, Sunday Review. Retrieved on February 9, 2014 from: http://www.nytimes.com/2013/08/11/opinion/sunday/when-doctors-discrimina... .
Kristof, N. (2014). Inside a Mental Hospital Called Jail. The New York Times, Sunday Review. Retrieved on February 9, 2014 from: http://www.nytimes.com/2014/02/09/opinion/sunday/inside-a-mental-hospita... .
Copyright Azadeh Aalai 2014