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June 5, 2013
The latest DSM is wide on lists and
thin on the root causes of mental illness. It took 14 years to produce but the
newest Diagnostic and Statistical Manual of Mental Disorders, DSM-5, was
published last month.
The first DSM was published in 1952. It was a spiral-bound pamphlet that listed
95 mental disorders. By 1986, the number of disorders in the DSM-II had climbed
to 130. Controversially, it made homosexuality a mental disorder which was later
revoked in 1973.
What makes it into the DSM is determined by a panel of experts. Psychologist
Carol Tavris thinks that this is an odd way of determining a disease. "Doctors
don't vote on whether pneumonia is a disease." Unlike biological illnesses,
mental illnesses come and go. Narcissistic Personality Disorder was voted out in
the DSM-II and voted back in the DSM-III of 1980. Where did it go?
The DSM reflects current psychological theories. In the nineteenth century,
Sigmund Freud believed that mental illness was caused by the mind trying to
resolve issues from the past. The DSM-III threw out Freud's theories along with
terms such "neurosis" and in the fashion of modern science, replaced them with
an list of disorders with agreed-upon symptoms.
Then the number of disorders was 300. Mental illnesses grew to nearly 400 with
the DSM-IV (1994). The latest DSM-5 drops the Roman Numerals and is 947 pages
thick.
Carol Tavris' favourite disorder in the DSM-5 is "antidepressant discontinuation
syndrome." Now psychiatrists can treat the symptoms of going off
antidepressants, which is a good thing because the inflated number of disorders
allows for doctors to prescribe more antidepressants for more problems.
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Dr. Kwame McKenzie, director for the Centre for Addiction and Mental Health
in Toronto, is concerned that the DSM-5 will turn normal behaviour into an
illness and lead to false epidemics of diseases that didn't exist prior to
the DSM-5.
Grief, for example, didn't used to be a mental illness. When Dr. McKenzie
began training in the 1980s, psychiatrists allowed grief to take its course
unless a patient was suicidal. Tranquilizers were ill-advised because they
interfered with the natural process for dealing with traumatic events.
Psychiatric intervention was only considered if grieving lasted more than
six months. The DSM-IV reduced the allowed time to two months and the DSM-5
to zero.
"Grieving is a personal and social process that reflects both how we deal
with mortality and the way we demonstrate the bonds between us. Depression
is part of the grieving process, a part of letting go as well as paying
one’s respects," worries McKenzie.
Another problem in all DSMs is that mental illnesses are classified without
determining an anatomical cause. What good is the diagnosis of a disease
without a source? Sure, trauma to the brain will lead to behavioural
changes. But brain illness is not necessarily mind illness.
The mind is a product of both society and anatomy. "If our minds are engaged
in a relationship with the world, then mental illness is the fault of
neither. It is the relationship between them that is problematic," explains
McKenzie. The DSM misses the root cause of mental illness by ignoring social
and relational factors. "We need to understand both the individual and the
environment, and how they interact, if we are truly going to improve the
world’s mental health."
David Charbonneau is the owner of Thompson Studio
He can be reached at
dcharbonneau13@shaw.ca
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