The Economist has an article titled “That way, madness lies: A new manual for diagnosing diseases of the psyche is about to be unveiled,” about the 2013 release of the American Psychiatric Association (APA) next revision of its Diagnostic and Statistical Manual of Mental Disorders (DSM-V). On Feb. 10 the APA plans to release a draft of the DSM-V. According to many critics, this process of revising the manual has been cloaked in secrecy and surrounded by uncertainty regarding the direction this manual and the diagnostic process will take. It doesn’t help that the effort to revise the manual has taken over ten years now, with three years to go before its intended publication. We have commented on the DSM and its hold on our culture in previous posts.

Our concerns about the manual and any revisions to it lie in how a diagnostic threshold is defined and then linked to who in fact has a major psychiatric disorder. The diagnostic threshold is where we better identify who specifically has crossed over to actually having a major psychiatric disorder, not casting a broader net over the general population in terms of who is suffering from mental illness. As we watch corporate pharmaceutical marketing campaigns gain ground in delivering direct to consumer use of serious psychiatric medications and merge with the spread of diagnosing more people with some form of mental illness across the globe our concerns take on a greater sense of urgency. Remember that for the majority of us, we are not as sick as we are told and/or think we are. Here is an excerpt from the article:

The original DSM reflected the “psychodynamic” view of mental illness, in which problems were thought to result from an interplay between personality and life history. (Think Freud, Jung and long hours recounting your childhood and dreams.) The third version, which was published in 1980, took a more medical approach. Mental illnesses were seen as distinct and classifiable, like physical diseases. DSM-III came with checklists of symptoms that allowed straightforward, unambiguous diagnosis. Psychiatry began to seem less like an art form and more like a science.

DSM-III also introduced many more diagnoses than had appeared before. These included attention-deficit disorder (see article), post-traumatic stress disorder and social phobia. In fact, the number of specific diagnoses more than doubled between DSM-I and DSM-III, from 106 to 265. DSM-IV, published in 1994, increased the number to 297, but left the underlying model alone.

The APA’s DSM-V task force, however, has suggested it would like to introduce a “new paradigm” into the manual. It wants to recognise that many conditions, such as anxiety and depression, tend to overlap, so that a diagnosis of only one or the other does not always make sense. The new version of the DSM is also expected to include a “dimensional” component, one that considers the severity as well as the nature of symptoms. This could lead to the paradoxical situation of a symptom (minor depression, for example) being classified as being below the threshold for the diagnosis of a disease, but nevertheless still being regarded as a problem—leaving the individual so diagnosed in a weird medical limbo.

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