December 30th, 2008

The politics of the DSM

It’s that time again—time for revision of the DSM, the diagnostic bible of therapy. This will be the fifth edition, and although it won’t be out for three more years, the controversies and jockeying for position are intense.

For those of you unfamiliar with this tome, it is essentially a list of psychological syndromes. As such, it is quite different from its medical equivalent, although it is based on the medical model (see this for some of the complex history behind the endeavor). The difference is that, as inexact a science as medicine is, the classification of mental and/or behavioral problems is barely a science at all. Politics, fashion, pragmatism, and special interests (all of which enter into medical diagnoses as well) are even more dramatically involved in the DSM system.

The main use of the book today is as a guide to treatment and medication, and especially as the key that opens the door to reimbursement. Insurance companies are focused on the categories listed by the DSM, and woe be the patient who does not fall into one of them. Fortunately, it’s almost always possible to find a niche for every patient, and to justify it.

According to the article, some of today’s arguments focus on whether problems such as binge eating and transgender issues should be included, or whether Asperger’s and high-functioning autism should be merged. The drug companies have an interest in many of these matters, as well, and their interest is in expanding the definitions of treatable problems to include more and more of the population.

This is not to say that the DSM is without merit. For example, whether a person is diagnosed as depressed or bipolar can point the way to the more effective medication for treament for that particular person, and save the time and trouble of trying so many ineffective remedies with major side effects. But anyone who thinks the DSM is not a reflection of politics and economics is just—well, there must be a diagnosis for that somewhere.

15 Responses to “The politics of the DSM”

  1. vanderleun Says:

    I’d put it as LBD: Liberal Brain Death.

  2. Wolla Dalbo Says:

    If I remember correctly, wasn’t homosexuality dropped from the disease/abnormal category during the last DSM revision, due to pressure from various homosexual activists/groups/psychiatrists and, in particular, because of a rigged vote on this issue by psychiatrists at a meeting of the American Psychiatric Association?

  3. vanderleun Says:

    And here’s another recent view:

    Ars Psychiatrica: Who’s Afraid of the DSM?

  4. Gringo Says:

    During my undergrad years I worked for a year as an aide ( “Mental Health Worker”) in a private psychiatric hospital before I took a course in Abnormal Psychology.

    My reaction to all the classification terminology in the Abnormal Psych course was that it was by and large useless in dealing with on the ward situations. In writing up notes in the psych hospital we were instructed to write what we observed, what we believed to be the dynamics behind what we observed, and our action/reaction to the situation. The writing guidelines were also useful in deciding how to react. Much more useful than the brouhaha of the Ab Psych classification/terminology.

  5. GeoPal Says:

    Will Messiah Complex still be considered a disorder? Wonder if All Tingly In The Legs syndrome made it?

  6. Ozyripus Says:

    This indeed is an interesting subject, neo. And I do not use the word “interesting” as the antonym for interesting.

    Aren’t most of our arguments about religion, politics, social standard, and getting a divorce — to one degree or another –arguments as to who is the crazy one?

    Does make for an interesting life.

  7. 11B40 Says:

    Greetings:

    When I took “Abnormal Psychology” back in college (back when homosexuality was still included) I remember the professor telling the class that they would find themselves on every page and that they would be wrong.

  8. huxley Says:

    I swear there’s a niche for a DSM board game.

  9. I R A Darth Aggie Says:

    I swear there’s a niche for a DSM board drinking game.

    There. Fixed it for you.

  10. Perfected democrat Says:

    “…there must be a diagnosis for that somewhere.”

    The one about insanity defined as the repetition of the same behaviour, while hoping for a different outcome; Oh, what relief, it’s time for my soma now, good night….

  11. Perfected democrat Says:

    Take your pill, life will be better in the morning…

  12. njcommuter Says:

    Actually, I think the diagnosis would be ‘naivete’. But there may be a large overlap between that and ‘liberal’, since the latter seems immune to learning from history.

  13. Tom Says:

    The present medical model, ICD-9, has been in use for a generation, so there are seriously outdated diagnoses; see lymphomas, for example. The update, ICD-10 has been in draft form for several years; but that’s the committee-consensus, WHO way.
    I will ask Neo to back up her charges re politics, fashion and special interests re ICD-9 with a few examples. I have no argument with her position on DSM.

  14. Bugs Says:

    Whatever I got, I hope they put it in this time.

  15. neo-neocon Says:

    Tom: The drug companies are involved heavily in the definitions of certain illnesses, such as when a person has high cholesterol that needs treating. The research is iffy in many ways, but the recommendations to treat keep widening, and more and more drugs are sold.

    There are also fashions in treatment—such as the widespread use of certain heart surgeries, and then later on more and more indication that many cases do just as well or better with medication.

    Very often recommendations of all sorts are made with little evidence, and then when the research comes in it turns out to be the opposite of what was thought (such as, for example, hormones for post-menopausal women to prevent heart disease).

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Previously a lifelong Democrat, born in New York and living in New England, surrounded by liberals on all sides, I've found myself slowly but surely leaving the fold and becoming that dread thing: a neocon.
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