Last month, the American Psychiatric Association (APA) released the fifth edition of its Diagnostic Statistical Manual (DSM). Physicians use this reference manual to describe, diagnose, and treat mental illnesses. It’s a resource for everything from bipolar disorder and depression to autism and anorexia. This is the fifth edition of the manual. And the APA publishes it roughly every 15 years.
Unfortunately, the new manual falls short in just about every imaginable way.
Many consider the manual the “bible” of modern psychiatry. But critics charge that the latest edition turns normal human experiences into “treatable” psychiatric conditions.
For example, the new instructions eliminate the “bereavement exclusion.” Previous manuals instructed physicians not to diagnose grieving patients with clinical depression. And certainly don’t medicate them. Psychiatrists once considered bereavement a very normal, even healthy, reaction to one of life’s most painful experiences.
Now, physicians have the green light to go ahead and medicate away life’s painful experiences with drugs. Presumably, the more drugs the better.
Indeed, critics say the new manual encourages physicians to prescribe far too many dangerous and unneeded drugs.
It’s no secret that modern psychiatric treatments now lean heavily on pharmacologic drug solutions. And away from psychotherapies and “talk” therapies.
Some would say treating mental illness with a drug makes the practice more “scientific.” But centuries of wisdom from other health traditions tells us otherwise.
What we now see as a psychiatric disorder is not just a “medical” problem. It is spiritual, involving not only mind, but also the body and soul. Matters of the spirit and soul have not lately been the province of modern medical practice. And certainly not pharmacology.
Thus, you can see how we’ve lost our way in the last 50 years by treating mental illness strictly as a chemical problem.
Since many modern scientists don’t really understand what causes psychiatric illnesses, they turn to statistics. The same goes for “mysterious” mind-body therapies. When a scientist doesn’t understand how a mind-body therapy works, and why it has worked for hundreds of years, they begin to describe it statistically.
For example, hypnosis is an “alternative” or “mind-body” therapy that’s been used successfully to treat any number of conditions for more than two centuries. Yet we still don’t understand exactly how it works.
But we do know that it does work.
So scientists deconstruct the solution. They come up with statistical profiles about who responded to the treatment. For what problems. Under what conditions. And with what success.
So we now know that 10 percent of men and women are very susceptible to hypnosis. And they have great success with the treatment. While 10 percent of men and women are resistant to it. The treatment doesn’t work well for these folks. Everyone else appears to fall somewhere in the middle
Similarly, modern psychiatry relies heavily on statistics to “prove” which treatments work and which don’t. And we try to predict what drug will work for which patients. But this isn’t always effective. And it fails to treat the whole person–body, mind, and spirit.
Lastly, critics say the new manual is simply a cash cow for psychiatrists and drug companies. (Given the close ties between many of the manual’s authors and editors, and major drug companies, the two have become almost indistinguishable anyway.)
The real harm of the latest DSM comes from its new and expanded categories of mental illnesses. This will most likely encourage increases in disability claims.
Therefore, insurance companies, government agencies, and the court system will hand out more money than ever to “new” mentally disabled patients. This gives far too much authority to organizations that simply shouldn’t have it. Plus, these patients, with the right treatments, could be working and living fully engaged lives
The DSM was once intended to direct patients to appropriate therapies first–not just consign them to the ranks of the disabled. But legions of government bureaucrats depend upon finding disabilities for their livelihood.
Fortunately, many real doctors know the new manual is just a book. Psychiatrists and other physicians should take it with a grain of salt. And together, with lots of common sense and clinical experience, they will continue to treat the whole person.
We can count on good psychiatrists to temper the manual’s instructions in their own practices. They will recognize that each person and each situation is different. That’s what all good doctors do with any medication or treatment.