Pathologies of the Diagnostic Statistics Manual of Mental Disorders (DSM)
by Lourdes Salvador
Monday, April 23, 2007
April 22, 2007
Pathologizing people who are dissimilar as mentally ill gives unreasonable and unprecedented power to those who chose conformity. Interestingly the real illness is often not experienced by the person who is living their life as they see fit, but rather the person who fears someone who is brave enough to live life as they see fit. Many mental illnesses are figments of our vivid imagination. Labeling choices and behaviors as disorders only causes harm in the long run. Choice and behavior is relative to the differences in human beings, their nature, their intelligence, and their personalities rather than mental illness.
Americans have an obsession with classifying and labeling every behavior as abnormal. However “many psychiatric "conditions" exist only as labels in the minds of psychologists” (Null, 2002). If everyone has a mental disorder they could be institutionalized and controlled like good little soldiers marching in a perfect line with uniforms on all moving at the same time, with the same haircut, the same polished shoes, the same goals, and the same objectives like a line of identical controlled robots. “You'll find that any normal behavior can be diagnosed as mental illness, and any adverse reactions to environmental influence, peer pressure and social unrest has earned a psychiatric label. If you don't wake up on time, if you sleep poorly, if you drink coffee or smoke cigarettes, or if you give up these things, if you stutter, if a child fidgets or loses things or can't wait their turn in a game, if you've ever been intoxicated, if you've had trouble with arithmetic or with grammar or with punctuation or writing expressively - all of these are now considered mental illnesses according to psychiatrists. Even teenagers who argue with their parents are, according to the DSM IV, suffering a mental disorder called oppositional defiance disorder” (Null, 2002). The DSM is premeditated to maximize conformity, promote pharmaceutical sales, and minimize individuality.
Perhaps most astounding is that symptoms of real physical illnesses such as malaise, fatigue, heart palpitations, dizziness, loss of energy, and pain are often used to make diagnoses of mental illness. For example, there is a DSM code for “pain disorder”. This leaves a window of opportunity open for a doctor to make a diagnosis of “pain disorder” if he is unable to find a cause for the pain. Most often the case is that not every test has been run because it is too time consuming, expensive, or the insurance will not pay for it. What authority allows such fallacious diagnoses? The DSM does!
The DSM is designed for power, control, and increased psycho-pharmacuetical revenues. It has more weaknesses than strengths. It is controversial because the DSM is the authoritative tool the powerful can use to exercise control over the masses and drug the country into oblivion. This generates huge profits for pharmaceutical companies and helps to raise campaign contributions for politicians.
In a recent news article Jeanne Lenzer (2004) comments “the president's commission found that "despite their prevalence, mental disorders often go undiagnosed" and recommended comprehensive mental health screening for "consumers of all ages," including preschool children.” Lenzer (2004) also confirms “Drug companies have contributed three times more to the campaign of George Bush”. “The medical and educational establishments are conducting a skyrocketing campaign to get kids, and their parents, to "just say yes" to brain-altering pharmaceuticals, with the drug of choice being Ritalin” (Null, 2002).
The DSM is published by the American Psychological Association to provide guidelines to diagnose mental disorders (Wikipedia, 2006). The DSM lists codes that practitioners use to bill insurance companies and collect statistics on conditions. Each code has a specific set of criteria by which a practitioner can diagnose a patient. The intention was to streamline the field and provide consistent, uniform, and objective terms through a multiaxial system. The belief was that all practitioners would reach the same diagnosis for a patient in this uniform system.
According to Wikipedia (2006) “the criteria and classification system of the DSM are based on a process of consultation and committee meetings involving primarily psychiatrists. Therefore, the content of the DSM does not reflect all opinions on the subject of psychopathology, emotional distress and social functioning. Nor are there any objective, biological verifiable standards to which it adheres. The criteria, and the way they are applied by individual clinicians are at least to some extent influenced by cultural variables and are periodically altered to reflect the contemporary social landscape. What is and what is not considered a mental disorder changes over time. For example, prior to a psychiatric plebiscite in 1973, homosexuality was listed in the DSM as a diagnosable mental illness.”
“Deconstructive critics assert that DSM invents illnesses and behaviors” (Wikipedia, 2006). The criteria for an illness in the DSM are subject to misinterpretation. For example the DSM code 300.82 is known as undifferentiated somatoform disorder. Clearly a somatoform disorder is another way for a doctor to say, “It’s all in your head”. Simply because a doctor cannot find a cause for chest pain does not mean there is not a cause for the pain that went undetected. All the therapy and psychobabble in the world to convince the patient he is not ill will not remove an artery blockage that a physician overlooked. In the long run therapy would only harm the patient as he became convinced he is mentally ill and begins to ignore important symptoms.
Physicians learn in medical school that 50 – 60 % (Ray & Oakley, 2003) of patients they will see do not have a physical disorder that can be treated by medicine but rather they present with a psychological disorder. Forty million people (Null, 2002) in the United States are diagnosed with depression. The DSM invents illnesses that are nonexistent by classifying normal behavior and human development as mental dysfunction.
In addition “it is also known that the diagnosis of some mental disorders is influenced by gender role expectations. That is, while diagnostic criteria do not mention gender, clinicians diagnose women's and men's behavior in different ways (Wikipedia, 2006). Clinicians own viewpoints can get in the way of an accurate diagnosis. A man who acts meek, shy, and compliant to the women in his life may be considered mentally ill while a woman would not. “Sexist values result in a higher rate of mental illness labeling for men, supposedly the more powerful social category, and less for women, who are generally powerless” (Keel, 2005). The way the DSM is classified does not allow for appropriate differences in gender role expectations nor does it discuss the etiology of supposed illness.
In Myth, Stereotype, and Cross-Gender Identity in the DSM-IV, Wilson & Hammond (1996) attack the DSM and the ridiculous issues that created classifications such as "transvestic fetishism". One has to wonder what good purpose the DSM was designed to serve.
Health insurance will not pay for services unless a diagnosis is made and a DSM code is provided. Labeling people with an illness can be counterproductive and actually cause more harm than good. If an individual is told they have anxiety disorder it will likely become a self-fulfilling prophecy. Years of therapy can do more harm than good when no real illness is present.
If we relied on the classifications in the DSM every person in the world would have a diagnosable mental illness. The pharmaceutical companies will make more money and support physicians through bonus programs to make these diagnoses.
The bottom line is if we make a choice or behavior wrong by psychologizing it, we give power to those who choose conformity and institutionalize otherwise mentally healthy people who choose a unique path. Sadly the DSM has no business in treatment with its current classifications. It is merely a tool used to label a person and bill insurance companies. Labels are hurtful and can alter a person’s psyche for the worse. There are other more effective methods of billing that could be arranged such as time billing. The world would be a much better place if doctors found out what was really wrong with people and allowed people to make individual choices.
The sad reality is doctors make more money when people stay sick. Pharmaceutical companies make more money when we take drugs for non-existent illnesses, often causing real damage. Many psycho-pharmaceuticals are known to cause violent and suicidal behaviors. In other words, they create mental illness rather than treat it. The discrimination created by labeling those who chose or require different orientations that suit them is criminal!
American Psychiatric Association (2000). DSM-IV-TR Arlington: American Psychiatric Association
Keel, Robert (2005). Mental Disorder: The Medicalization of Deviance.
Retrieved March 24, 2006 from: http://www.umsl.edu/~rkeel/200/mendisor.html
Lenzer, J. (2004). Bush Plans to Screen Whole US Population for Mental Illness. BMJ Publishing Group.
Retrieved March 24, 2006 from: http://bmj.bmjjournals.com/cgi/content/full/328/7454/1458
Null, G. (2002). Pathologizing Life. Retrieved March 25, 2006 from: http://www.garynull.com/Documents/PathologizingLife.htm
Ray, C. & Oakley, C. 2003. Drugs, Society, and Human Behavior. 10th Edition.
New York: McGraw-Hill Companies
Wikipedia (2006). Diagnostic and Statistical Manual of Mental Disorders
Retrieved on March 21, 2006 from: http://en.wikipedia.org/wiki/Diagnostic_and_Statistical_Manual_of_Mental_Disorders
Wilson, K. & Hammond, B. (1996). Myth, Stereotype, and Cross-Gender Identity in the DSM-IV. 21st Annual Feminist Psychology Conference. Retrieved 3/25/2006 from: http://www.transgender.org/gidr/kwawp96.html
About the Author
Lourdes Salvador is a writer and social advocate based in Hawaii.
She is the president of MCS America and a featured monthly writer for MCS America News at www.mcs-america.org.
She is a passionate advocate for the homeless, having worked with her local governor to open new shelters and provide services to the homeless based on a presentation of her ideas.
That passion soon turned to advocacy and activism for victims of multiple chemical sensitivity.
For more information about Lourdes and her advocacy work, please visit:
Copyrighted © 2007 Lourdes Salvador
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