Diagnostic and Statistical Manual of Mental Disorders

Not sick, just behaving badly

Janet Albrechtsen From:

The Australian March 03, 2010 12:00AM

MEDICAL advances can take your breath away. Over the past decade, medical experts have started decoding the human genome to provide genetically-personalised medicine.

The experts behind these advances are geniuses. Perhaps in the same vein, the psychiatric profession imagines that their new bible of mental disorders — more than 10 years in the making — will be hailed as milestone of medical achievement. If so, they’d be wrong.

Released last month as a draft, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders is a depressing testament to the medicalisation of modern society where every deviation from what is deemed normal behaviour is labelled as a mental disorder.

Known colloquially as DSM 5, the manual routinely used worldwide as the diagnostic tool for mental disorders is proposing to add a range of new mental disorders to the mushrooming list of existing ones. Your house is getting cluttered because you can’t bring yourself to throw anything away? Perhaps you have hoarding disorder. Having trouble with maths? Maybe you have mathematics disorder or discalculia as the experts call it. You’re approaching 70 and not remembering things like you used to? We call it ageing. The American Psychiatric Association wants to call it minor neurocognitive disorder. Your seven-year-old child is having frequent temper tantrums? Put it down to temper dysfunctional disorder with dysphoria.

Do you spend a “great deal of time” consumed by sexual fantasies? Using sex to deal with a stressful life? Having too much sex? We might say good luck to you. What is too much sex anyway? The experts know and they call it hypersexual disorder. Hence Tiger Woods was in a medical clinic apparently being cured of his sexual attraction to strippers.

When you lost someone you loved, did you grieve for longer than deemed normal? DSM 5 wants to medicalise that, too. How does society decide what is normal grieving and what is not? How can experts measure the depth of a love that may explain the intensity of the grief? Death and grief — like life and love — are deeply personal experiences beyond the realm of something called normal behaviour.

A long period of deep grieving is not a disorder. For most, it’s called life.

These aren’t just silly labels. There are serious consequences. A small child we would once have called naughty or distracted or disorganised is now sent to experts for treatment. New drugs are produced and prescribed. Governments hand out taxpayers’ money based on recognised disorders.

Last year, researchers at Macquarie University found that the diagnosis of disorders such as oppositional defiant disorder had

risen by 600 per cent in Australian schools. One of the authors pointed to the international trend towards “gaming the system” where the perverse incentives mean that schools seek out extra funding by diagnosing behavioural problems.

Many disorders are explained more by societal fashions than steady science-based research. Earlier editions of DSM listed nymphomania as a mental disorder. A woman who enjoyed sex too much was mentally disturbed. Then along came the sexual revolution. Thank goodness. Thomas Zander, a clinical and forensic psychologist critical of attempts to create dubious disorders, points to the vigorous debate in 1973 as to whether homosexuality should be labelled a mental disorder. It was rejected. It could have gone the other way.

In the 21st century, the focus is now on “behavioural addictions”. As critics of DSM 5 point out, it won’t be long before psychiatrists are treating addictions to shopping, work, using credit cards, videogames and the internet.

Pathologising people who don’t have real problems is bad enough. Even worse, modern psychiatry is pushing us further towards the medicalisation of crimes where personal responsibility is displaced by an ill-defined mental disorder. It is proposed that the revised diagnostic manual relied on worldwide by lawmakers and expert witnesses in criminal trials will classify rape fantasies as the sign of a newly recognised mental illness.

A rapist will be able to claim they frequently get aroused by fantasies about non-consensual sex. If the rapist acts on those urges more than once, the experts want to label that as paraphilic coercive disorder. You can see where this is going. A one-time rapist doesn’t get a get-out-of-jail card. But commit a couple of rapes, point to your penchant for bondage porn and you can argue for leniency in court on the basis of a mental illness.

PCD has a dubious history. Having failed previously to get it included in the diagnostic manual, experts are having another go despite a range of critics who have long argued against the vague and unconvincing research. Without firm science on their side, the push to allow criminals to evade personal responsibility is a dangerous move to pathologise rapists as just another category of victim, rather than punish them for their crimes.

Alas, pragmatism can be a scarce resource in the ivory towers of academe where there is an inclination towards institutional bias. Work groups responsible for different sections of the DSM have a natural tendency to push the boundaries and over-hype their case to gain formal recognition for their new disorder. Careers, grants and prestige depend on it.

As one critic wrote last month, this “diagnostic imperialism must always be recognised and resisted.” The critic was Allen Frances, professor emeritus of the department of psychiatry at Duke University and the man once described by The New York Times as the “most powerful psychiatrist in America”. More than a decade ago, Frances was in charge of drafting DSM 4, the present version of the diagnostic manual.

In other words, he knows what he’s talking about when it comes to the alarming medicalisation of human behaviour.


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