C.R. writes: No. The title of this blog post isn’t a joke. It is based on a series of alarming articles I just read about the new edition of the perennially controversial DSM.
In a Reuters piece, Peter Kinderman, a British clinical psychologist and head of the Institute of Psychology at Liverpool University was quoted as saying:
“The proposed revision to DSM … will exacerbate the problems that result from trying to fit a medical, diagnostic system to problems that just don’t fit nicely into those boxes,” said Peter Kinderman at a briefing about widespread concerns over the book in London.
He said the new edition – known as DSM-5 – “will pathologise a wide range of problems which should never be thought of as mental illnesses”.
“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” he said. “It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.
Whatever the politics, wherever the money-trail leads, the truth is that the DSM has its good points and bad. As a non-mental health professional, merely an amateur (in the good sense of the word, I hope), a psychological and social psychological sleuth, my opinion might be on the simple side, but here it is: It is good that the DSM has categorized mental illnesses because this can lead to more effective treatment and it is not so good that the DSM has categorized mental illnesses because this can lead to pathologizing what are mere “personality differences or lifestyle choices.”
I also worry about the trend towards therapeutically treating children for everything from a lisp to a bit of rebelliousness. For example, shyness isn’t pleasant, but many children really do grow out of it (I did). I’m not talking about a pervasive, omnipresent phobia, but still, somewhat serious shyness.
Grief and sadness aren’t pleasant either, but they are appropriate feelings at many times in our lives. An over-eager diagnostician might label one person’s appropriate sadness as clinical depression. If we rush to judgment anytime we feel or display an “unacceptable” emotion we can turn anything into a mental illness.
For example, study after study shows that divorce has a lasting effect on children. Children are saddened, often deeply, to see their parents split up, for a variety of reasons. Do they need counseling? Maybe. Do they need medication? Only in very rare instances. Grief as a response to the losses divorce entails is a very natural, healthy response to the situation.
A couple of years ago an editing client of mine asked me what I thought about her daughter. The school felt she had “oppositional defiant disorder.” I knew both mother and daughter and had spent time with them together. I felt she was a basically loving young teen who just going through a normal phase of declaring her autonomy. I hesitated to tell my friend my opinion—after all, I’m not a therapist (and I took pains to tell her my opinion was personal, not professional).
But I did anyway. And you know what? Within 16 or so months, her daughter had worked her rebelliousness through. If she had gone for an evaluation, she might have been told she needed therapy. Or medication. What she eventually found she needed was to sit down and talk with her mom about who she was becoming, who she was, and how to find balance between being part of a family and being an individual. She had to make sense of her limitations and her options.
The DSM in general is helpful, but some of the information coming out is particularly worrisome because of the chance children will be over-diagnosed and unnecessarily medicated. I’m in a multi-family dwelling where each day numerous children play in the common area right outside the door where I work. (It’s fun to open it and say hi and see their cute, surprised faces). They scream and shout and spin themselves around until they are dizzy. They pretend they are firefighters and astronauts and mommies and teachers. They talk to themselves. They sulk and sometimes hit each other. They experiment with smashing tricycles into my door. They share secrets and invent hysterically funny (at least to them) scenarios. Not a day goes by without a mom getting slightly fed up and a child shedding at least a few tears. All in all, normal kid stuff.
Objectively speaking, children look and act out of touch with reality. That’s because they need to live part of the time in their imaginary worlds where they can test out various scenarios safely. They can explore and go beyond boundaries in their imaginations and through this, they learn who they are.
When they test things out behaviorally, the behavior might be annoying, upsetting, or inconvenient. That is one of the challenges of raising children. Today, many caring parents are so well-informed and so involved that they may at times over-analyze these behaviors.
Meanwhile, most of the time, sadness is not a mental illness or indicative of mental illness, especially when it is in response to recent painful events. If you lose a friend, pet, or job; if you move; if you have an argument with your best friend you’ll probably feel sad. Maybe even for awhile. We read the list of what might indicate depression and what is “normal”. But if we’re narrowing in on sadness in general, we might be off track. There are people who are quieter, not so overtly happy, maybe even a little melancholy but those might be a part of a person’s personality, not an illness.
Mental health professionals are expressing a lot of concern at the changes in the DSM. Sure, there may be politics and, naturally, money-related stuff going on, but:
Allen Frances, Emeritus professor at Duke University and chair of the committee that oversaw the previous DSM revision, said the proposed DSM-5 would “radically and recklessly expand the boundaries of psychiatry” and result in the “medicalisation of normality, individual difference, and criminality.”
Even if he’s only partially correct, he gives us serious food for thought.