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.