The DSM and pathologizing human experiences and giftedness
Posted Mar 03 2010 7:58pm
Many people have been helped by professionals who make use of the labels and categories of mental health issues detailed in the Diagnostic and Statistical Manual of Mental Disorders, or DSM.
But many critics question the institutionalized categorizing of so much human behavior as “disorder” instead of ordinary experience, healthy divergence or even aspects of giftedness.
Labels – inside or outside the DSM – can help many of us who have had mental health challenges better understand our experiences, and lead us to treatments or self-help material.
For example, Ashley Judd – one of my favorite actors and, by the way, a Phi Beta Kappa grad of the University of Kentucky – entered a treatment program in 2006 for personal issues, including depression and codependency.
She has commented, “All I know is that I am grateful now for those experiences because I had the opportunity to do a lot of healing work on myself.”
A magazine profile reported that earlier in her life, at age 25, she “found herself to be ‘tearful. I was so tender that I couldn’t really rebound.’ She diagnosed herself courtesy of a pamphlet in a doctor’s waiting room. A doctor later confirmed it: mild anxious depression.”
Judd added, “I asked, ‘What else do you call it?’ and he said, ‘Unresolved childhood grief.’ I thought, ‘Okay,’ because that gave me something to do, something to expunge. As Rilke said, you sometimes have to live the question.” [From article: That Touch of Minx by Johanna Schneller, Premiere, May 2000.]
There are many of us who have experienced clinical depression, one of the conditions listed in the DSM, which means, among other things, insurance coverage is more likely, and psychologists and psychiatrists have more specific guidelines on treatment.
I have used antidepressants at times earlier in my life, though not for years. But I still use SAM-e and St. John’s Wort.**
Normality as disorder
In his LA Times Opinion piece It’s not too late to save ‘normal’ [republished on this site], Allen Frances declares “Psychiatry’s latest DSM goes too far in creating new mental disorders.”
He continues, “As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.
“Our panel tried hard to be conservative and careful but inadvertently contributed to three false ‘epidemics’ — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many ‘patients’ who might have been far better off never entering the mental health system.”
Real or unreal behavioral addictions
The photo of DSM manuals is from the article Caught in the web? You need help, not labels , which talks about new addiction-related labels being proposed for the next edition: “By sanctioning behavioral addictions the new DSM opens the diagnostic door to the full menu of confessional daytime TV problems: gambling, shopping, eating, playing World of Warcraft, visiting porn sites, chatting online, having sex with dozens of women with teased blonde hair (hello Tiger), getting too many tattoos, hoarding newspapers (addicted to print!), or whatever else comes along.”
Pills for everything and the smiley face conspiracy
In his New Yorker article Can psychiatry be a science? Louis Menand notes “There is suspicion that the pharmaceutical industry is cooking the studies that prove that antidepressant drugs are safe and effective, and that the industry’s direct-to-consumer advertising is encouraging people to demand pills to cure conditions that are not diseases (like shyness) or to get through ordinary life problems (like being laid off).”
He refers to the book Manufacturing Depression by Gary Greenberg – a “grand tour of the history of modern medicine, as well as an up-close look at contemporary practices, including clinical drug trials, cognitive-behavioral therapy, and brain imaging.”
Menand says, “Greenberg basically regards the pathologizing of melancholy and despair, and the invention of pills designed to relieve people of those feelings, as a vast capitalist conspiracy to paste a big smiley face over a world that we have good reason to feel sick about.
“The aim of the conspiracy is to convince us that it’s all in our heads, or, specifically, in our brains—that our unhappiness is a chemical problem, not an existential one.”
Constructing the DSM
In my interview with psychologist Paula J. Caplan, Ph.D. [several years ago], who was formerly a consultant on an edition of the DSM, she said “American Psychiatric Association, that produces the manual of mental disorders that everyone uses, the DSM, markets it as science, even though it isn’t.
“My own experiences with the DSM committee, and my own research prove that. There are things in there that have even been proven not to exist. And when they were writing the DSM and trying to come up with a definition of ‘mental disorder’, they are on record as saying, basically, they had a heck of a time.
“And if you read the definition they used, there are loopholes you can drive a truck through. So I don’t think we can just blindly say, yes, there are things called mental disorders.”
“The most common mis-diagnoses are: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (OD), Obsessive Compulsive Disorder (OCD), and Mood Disorders such as Cyclothymic Disorder, Dysthymic Disorder, Depression, and Bi-Polar Disorder.
“These common mis-diagnoses stem from an ignorance among professionals about specific social and emotional characteristics of gifted children which are then mistakenly assumed by these professionals to be signs of pathology.”
** St. John’s wort “is an herbal remedy that has long been used in Europe as a treatment for mood disorders. Standardized extracts have shown an effectiveness equaling Prozac in the treatment of mild to moderate forms of the disease.” Info from HBC Protocols which sells research-grade formulations including Hypericum Perforatum / St. Johns Wort, and SAMe (S-adenosylmethionine).