New rules on psychiatric diagnosis are misguidedby Anjana Ahuja / February 22, 2012 / Leave a comment
In 1973, the American psychologist David Rosenhan sent eight healthy people, and also himself, to visit mental institutions and claim they were hearing voices. All were certified mad; some were incarcerated for a month. Rosenhan’s paper, “On Being Sane in Insane Places,” created a media sensation and a crisis in psychiatry. Doctors, it seemed, unlike suspicious fellow patients, could not tell a lucid stooge from a lunatic.
The ensuing controversy led to the tightening of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM), the “psychiatrists’ bible” that lists mental disorders and their symptoms. The DSM, first published in 1952, is produced by the American Psychiatric Association (APA), which, every decade or two, assembles a hundred or so mental health professionals to review disorders in the light of new science or shifting cultural norms.
A DSM review process is underway, with a new edition—DSM-5—due for publication in 2013. But psychiatry is again facing a Rosenhan moment: DSM-5 vastly expands the boundaries of mental illness, so that many people previously thought merely eccentric or mildly troubled could now be classified as mentally disordered. Grieving relatives will be labelled “depressed,” hotheads will now suffer from “temper dysregulation,” and forgetful seniors will be diagnosed with “mild neurocognitive decline.” More people will be caught in the diagnostic net, and potentially medicated, exposing them to side effects, plus all the professional and social difficulties that a diagnosis brings. Allen Frances, who edited the DSM-4, has come out of retirement to denounce DSM-5 as a “wholesale imperial medicalisation of normality” and a “bonanza for the pharmaceutical industry.”
A final draft is scheduled to come out in May and a period of public consultation will follow. But opposition is already considerable. A petition of protest has garnered 11,500 signatures, largely from members of the American Psychological Association, the American Counselling Association and the British Psychological Society. There was an outpouring of criticism in Britain and Simon Wessely, from the Institute of Psychiatry in London, noted: “By 1917 the American Psychiatric Association recognised 59 disorders, rising to 128 in 1959, 227 in 1980, and 347 in the last revision [DSM-5]. Do we really need all these labels?” Lucy Johnstone, a consultant clinical psychologist, said the DSM “cannot be reformed… it should be abandoned.” But the APA stands by its product: “We are confident that the DSM-5 will be based on the most reliable scientific and clinical data.”