If you’ve seen a GP in the last fifteen years, you are likely familiar with the rhythm of a checklist.
Do you feel distracted, irritable or empty?
Are you unable to sleep or unable to wake?
Do you eat too much or too little?
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Check five of the boxes in a diagnostic code and agree that these have been present for a fortnight. Congratulations. You’re depressed.
In 1994 the American Psychiatric Association published its fourth revision of the Diagnostic and Statistical Manual for mental disorders (DSM). Here, you’ll find the one-size-fits-most measure for Depressive Disorder. You’ll also find Breathing-Related Sleep Disorder and Nicotine Dependence; nuisances some of us prefer to know as snoring and smoking.
The taxonomy of bad habits and crappy moods would be funny if the DSM-V wasn’t such a blockbuster. Millions, possibly billions, will be judged against its criteria. This is the foremost tool for diagnosis of mental disorders in the United States and its influence here is great.
Professor Louise Newman, academic, practitioner and President Elect of The Royal Australian and New Zealand College of Psychiatrists, says of the document, “It’s widely referred to and used.” However, she says, the DSM-V is not quite the bible it is in the US.
Newman agrees that there is a local tendency to, “the medicalisation of normal experience and sadness.” She believes that therapists should not rely on the DSM-IV alone but take into account a patient’s, “lived experience and their meaning for that person it a social and cultural context.” She sounds like a good shrink.
There are those, however, who take the DSM-IV at its word. You’re not going to hear the question, “tell me about your mother” uttered much these days. Depression can now be diagnosed free from any social or cultural mooring.
According to the DSM-IV, the “bereavement exclusion”, or the death of a loved one, is the sole instance in which a practitioner might look at a patient’s life before diagnosing. And, before prescribing. Estimates suggest that more than 12 million prescriptions for Selective Serotonin Reuptake Inhibitors (Prozac and all its chemical cousins) are prescribed, primarily by GPs, annually in Australia.
GPs, government campaigns and organisations like Beyond Blue are heavily influenced by the DSM’s context-free style. Newman says, “We have a particular popular culture that looks for explanatory models that are probably too simplistic.” What we also have is a new revision of the DSM.
The DSM-V is due for publication in 2012. In the lead up to the revision, some scholars and policy makers have been campaigning for a document less inclined to medicalise the everyday. It seems, however, that the opposite has been true.
A raft of disorders, it seems, will be added to the document. Naturally, Internet Addiction Disorder is among them. Reports suggest that buying too many clothes, having too few Facebook friends and anger at job loss will be among them. You’re not broke. In fact, you have post-traumatic embitterment disorder.
To the indignation of many, notably the editor of the DSM-IV Allen Frances, participants at the American Psychiatric Association conference have been asked to sign a Non Disclosure Agreement.
Frances demanded transparency. He also suggested that psychiatry had enjoyed so few scientific breakthroughs across the last two decades that a new edition was futile. And he’s right. Psychiatry has virtually no “biological markers”. It doesn’t have urine tests or magnetic imaging to determine the mental health of a patient. It has the DSM.
Naturally, members of the APA were aghast. Some suggested that Frances was attempting to buoy his royalty cheque by extending the life of his own revision. Then, Frances suggested that the new document was nothing but, “a bonanza for the pharmaceutical industry.” And many pundits agreed.
In the meantime, a group of shrinks are sitting around and concocting new mental disorders. And this will have, at the very least, two consequences.
First, the estimate by the World Health Organization that by 2020, depression will be the leading health concern of the world should be right on target.
Second, real mental illness will go trivialized and untreated by a profession that devotes its therapeutic attention to curing World of Warcraft “addiction”.