The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is the psychologist's bible. It is enduring its sixth revision and in its 886 pages are the diagnostic criteria, treatment options and insurance coverage requirements to over 295 mental disorders. It was first published in 1952, by the American Psychiatric Association, and was adopted from an earlier classification system developed by the Bureau of the Census. Its first edition had only 106 mental disorders and quickly grew to 182 disorders with the release of the DSM-II. Early texts reflected the predominant psychiatry. In other words, symptoms were not specified explicitly, but were referenced as mere reflections of broader underlying conflicts or abnormal reactions to life problems.
Since the introduction of the DSM-II, many contributions have been made by a variety of professionals. Of these contributions are 115 additional disorders, the removal of more than twenty disorders (homosexuality, menopausal stress disorder and neurosis to name a few) a multitude of categories were renamed (ex: Bi-Polar disorder changed to Manic-Depressant Disorder), diagnostic criteria were updated and included symptom profiles, social and relational factors were also considered within the diagnostic criteria. As of right now, the DSM is undergoing another revision, which is expected to be released in early 2012.
The DSM-IV is also used by more people than ever before. Historically, it was primarily used by mental health professionals to communicate a patient's diagnosis after an evaluation, but hospitals, clinics, insurance companies, counselors, and even school teachers have cracked it open to "gain a better understanding" of their patients, clients and students behaviors. As you may have guessed, this has wrought a slew of political, relational and economic controversy.
So why did I just give you a three paragraph history of something that you probably have never even heard of? Well, within the past week my eyes have been opened to the many criticisms concerning the use and misuse of this widely circulated book. One of my close friends has been sharing his struggles with the mental health industry on his blog, which has contributed to the awaking I have had during the last couple of weeks. If you are interested in a more personal account than check his blog out
here. Also, there are many professional criticisms surrounding the DSM.
Many believe that the practical reliability of the DSM suffers because it is based on statistical criteria rather than sound, interaction based, accounts. Others still believe that the DSM unjustly categorizes disorders, and that it fails to provide a thorough representation of the available evidence concerning the various disorders. Recently, Keyes (2006) wrote about the DSM's failure to acknowledge the importance of mental health. He argues that physicians and psychotherapists have placed too much emphasis on the eradication of mental illness, rather than the improvement of mental health. He released a convincing study showing the parallel nature of the two, and later discussed whether or not the mental health community should pursue mental health or the "curing" of mental illnesses. Naturally, whichever option we pursue, there will be pros and cons.
Whether you support, disagree with, or have never had, or never will, have an opinion on this it is important to understand how our physicians decide whether or not we are crazy. Sadly I can't write any more about this right now. I am at Powell's Books in downtown Portland and the parking meter on my car ran out a while ago. Considering I have $40 dollars to my name right now, I am going to go so as not to get a ticket. I will write more later.
