Labelling, Stigma and Treatments: The Impact of the DSM

The Diagnostic Statistical Manual of Mental Disorders (DSM) has generated a lot of controversy for such a seemingly dull book. However, as the debate seems to rage between psychologists and psychiatrists, who are experts on mental wellness, is there any reason for us regular folk to bother about the furore over what constitutes a mental health “condition”? For Mary O’Hara, a social affairs writer and Alistair Cooke Fulbright Scholar 2009/2010, the simple answer is yes.

According to O’Hara, ‘For a start, esoteric debates about what mental illness is, and whether it is a result of biological or cultural triggers, are unlikely to be at the top of most people’s “pay attention” list. However, for people with a mental health diagnosis, the DSM and its consequences are far from obscure. It has, for decades, been influential and regarded as the bible for doctors who deliver psychiatric diagnoses.’

Not only does the DSM manual influence what clinical treatment you receive to improve your mental wellness – and, believe me, its influence is huge – the DSM also an impact on how you are labelled, or stigmatised, by wider society for your mental health condition. Until 1973, for instance, homosexuality was deemed a treatable mental illness! Yet while the DSM has eliminated such diagnoses now, some critics believe that as the manual has expanded, and increasingly over-medicalised normal behavioural responses such as after a tragedy or bereavement.

O’Hara explains, ‘As 70% of the experts serving on the committees that decided which conditions are in or out of DSM-5 have links to pharmaceutical companies, it is hardly surprising that scepticism abounds. With each edition of the DSM, new conditions are added, with some attracting opprobrium. Among those added in DSM-5 is “hoarding disorder”, defined as “persistent difficulty discarding or parting with possessions, regardless of actual value”. If new and extra conditions are becoming accepted so readily within psychiatric circles, shouldn’t we at the very least explore this trend?’

She adds, ‘When it comes to mental health, the diagnostic labels matters far beyond their clinical applications. A diagnosis all too quickly becomes a label by which an individual is defined and judged, which in turn becomes a catalyst for stigma and discrimination. There is evidence from the campaign, Time to Change, and others, that, even while there are some signs of a reduction, stigma and discrimination around mental illness are devilishly entrenched – with sometimes devastating consequences for those on the receiving end.’

Categories: DSM, mental illness, stigma

Are Doctors Too Quick to Diagnose Mental Health Problems?

It seems like mental health problems are on the rise, as is our need for medications – or is it? According to James Davies, author of Cracked and a psychological therapist who has worked for the NHS and the mental health charity Mind, this rise in mental illness is down to the pursuit of medical status.

Davies interviewed Sarah Jones, a mother of two and a care worker in West London, about her seven-year-old son Dominic. ‘Dominic is a lovely boy, but last year he started getting agitated and aggressive. He was doing badly at school and then he got into a fight,’ she says, adding that her son was diagnosed with ADHD after a 25-minute doctor’s assessment. ‘Dominic is on pills. He seems less distracted sometimes, but he also doesn’t seem himself either. It feels as if a part of his spirit has gone.’

In the past ten years, ADHD diagnoses have risen so sharply that roughly 5% of children in Europe are thought to have it, and an estimated 15% of children fall under the criteria of a diagnosable mental disorder. This figure was more like one in 100 in the Fifties, so why has child mental wellness taken such a turn for the worse? Davies argues that much of the profession’s claimed knowledge about diagnosing mental illness is scientifically baseless, as scientifically objective tests don’t exist in psychiatry.

According to Dr Robert Spitzer, the Columbia University psychiatrist, who was in charge of compiling the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), which sets the trend for modern psychiatric practice,  ‘There are only a handful of mental disorders in the DSM known to have a clear biological cause. These are known as the organic disorders [such as epilepsy and Alzheimer’s]. These are few and far between.’

Renee Garfinkel, a psychologist who participated in two committees that helped to compile the DSM-III, commented ‘On one occasion there was a discussion about whether a particular behaviour should be classed as a symptom of a particular disorder. To my astonishment, one committee member piped up: “Oh no, no, we can’t include that behaviour as a symptom, because I do that.” So it was decided that behaviour would not be included because, presumably, if someone on the committee does it, it must be normal.’

Are Doctors Too Quick to Diagnose Mental Health Problems?

Categories: ADHD, DSM, Over-Diagnosing

Psychiatrists Say Mental Health is an Issue, Not an Illness

If your wellness is affected by a mental health problem, such as schizophrenia or bipolar disorder, treating it in the same way as one would an illness is not helpful to your wellbeing. This is according to leading psychologists, who claim that even labelling the conditions is counterproductive, as there is no evidence that a ‘breakdown’ or ‘severe emotional distress’ is the same as an illness with genetic or biological causes.

This statement, released last week by the British Psychological Society’s division of clinical psychology, comes shortly before the release of the latest edition of American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM classifies many emotional and behavioural problems – including temper tantrums and excess worrying about personal health – as illnesses. This indicates that they are treatable by doctors using drugs.

According to Dr Lucy Johnstone, a consultant clinical psychologist who helped draw up the statement, there is no scientific basis for treating ‘emotional distress’ as a physical sickness. She commented, ‘No one is denying that people suffer very extreme forms of distress. What we are saying, and in fact what some of the world’s most senior psychiatrists are saying, is that there is no evidence that this kind of breakdown is best understood as an illness, with genetic or biochemical causes.’

She continued, ‘On the other hand, we do have an overwhelming amount of evidence that even severe psychiatric breakdown is the end result of a complex mix of social and psychological circumstances – in other words, things that have happened to you.’ Dr Johnstone argued that the new approach must regard mental distress as ‘people with problems, not patients with illnesses’.

Dr Johnstone explained, ‘People break down for reasons in their lives, and unless we can understand those reasons we will not be able to offer them the right kind of help to recover.’ Obviously our brains and bodies are involved in mental distress. The question is; is there evidence that distress is mainly caused by changes in our bodies and brains? There is no evidence to support this – as senior psychiatrists themselves are admitting.’

However, Professor Sir Simon Wessely, a member of the Royal College of Psychiatrists and chair of psychological medicine at King’s College London, argued that a classification system for mental disorder was necessary, and the DCP’s views have proven controversial within the medical community. He noted, ‘A classification system is like a map. And just as any map is only provisional, ready to be changed as the landscape changes, so does classification.’

Psychiatrists Say Mental Health is an Issue, Not an Illness

Categories: DSM, illness, scientfic basis