Personal reflection on DSM V: “being human is itself fast becoming a condition”

An op-ed worth reading in the New York Times – “Diagnosis:  Human.”

Journalist-author Ted Gup, a fellow of the Edmond J. Safra Center for Ethics at Harvard University, tells the tragic story of his son, one of the “11 percent of school-age children (who) now receive a diagnosis of attention deficit hyperactivity disorder — some 6.4 million.” I won’t try to recapture that part of what he wrote – it should be read it in its entirety.

But since we focus on media messages on this site, I want to emphasize this part of what Gup wrote (and the bold italics are mine):

“In May, the American Psychiatric Association will publish its D.S.M. 5, the Diagnostic and Statistical Manual of Mental Disorders. It is called the bible of the profession. Its latest iteration, like those before, is not merely a window on the profession but on the culture it serves, both reflecting and shaping societal norms. (For instance, until the 1970s, it categorized homosexuality as a mental illness.)

One of the new, more controversial provisions expands depression to include some forms of grief. On its face it makes sense. The grieving often display all the common indicators of depression — loss of interest in life, loss of appetite, irregular sleep patterns, low functionality, etc. But as others have observed, those same symptoms are the very hallmarks of grief itself.

Ours is an age in which the airwaves and media are one large drug emporium that claims to fix everything from sleep to sex. I fear that being human is itself fast becoming a condition. It’s as if we are trying to contain grief, and the absolute pain of a loss like mine. We have become increasingly disassociated and estranged from the patterns of life and death, uncomfortable with the messiness of our own humanity, aging and, ultimately, mortality.

Challenge and hardship have become pathologized and monetized. Instead of enhancing our coping skills, we undermine them and seek shortcuts where there are none, eroding the resilience upon which each of us, at some point in our lives, must rely. Diagnosing grief as a part of depression runs the very real risk of delegitimizing that which is most human — the bonds of our love and attachment to one another. The new entry in the D.S.M. cannot tame grief by giving it a name or a subsection, nor render it less frightening or more manageable.”


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Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

David Blistein

April 3, 2013 at 3:17 pm

The DSM serves several purposes. It gives professionals a rudimentary language with which to exchange information. It gives insurance companies rudimentary codes for approving or denying coverage. It gives drug companies and alternative medicine companies (e.g., supplements, herbs, tinctures) etc. a focus for their R&D efforts and marketing. As for the media, while they can be accused of selling snake oil at times, one of the ways they pay their bills is by advertising—and their right to do so is one of our fundamental freedoms. Finally, albeit indiectly, the DSM also provides us ordinary humans with a way to talk about all of the above.

It’s easy to be bemused, if not outright cynical about how these raisons d’être have ended up manifesting, but I’m not sure that’s fair. Health care professionals do need a common language—and, interestingly, seem to have fairly good ones for every illness except mental illness. Insurance companies do have to have some sort of criteria in order to perform risk management and determine coverage. Companies who develop medications—whether pharmaceutical or alternative—do need to focus their research and development. Media outlets do need to be profitable or at least break even. And at least in America, we have bestowed upon ourselves the unalienable right to pursue happiness.

So far, it may sound like I’m an apologist for psychiatrists, health insurance companies, medication companies, the media, and even the general population. Unpopular positions indeed these days! I’m simply trying to illustrate how interdependent (one could say co-dependent) all these players are. And that as soon as we vilify any one or more of them, we not only lose sight of the big picture but also our place in it.

The actions of all these players are certainly symptoms of some underlying place that humans are in their evolution at this point. But none share any more of the perceived credit or blame for this than any other.

So where does that leave us? On the surface, it might seem to leave us without any hope of making any substantive change—either as individuals or in groups. Because we humans tend to believe that the only way to really create something new is to destroy something else—that victimization and vilification are inevitable aspects of change.

I don’t see it that way. I think both make us less able to make real change.

When I suggest to people that they don’t necessarily have to do what their doctors, drug companies, or even friends and family tell them, they tend to heave a sigh of relief. They can of course. It might even make them feel better. But there’s no need for them to be tortured by the thought that they are doing something wrong if they choose or don’t choose this or that therapy to deal with this or that condition. They don’t even need to feel like they have to deal with that condition at all. Rather they can take a deep breath and say ok, this is where I’m at, this is where I would like to be, and I’m going to be very open about how I try to get there. I’ll listen to suggestions. But ultimately I make my own decisions.

I hope this doesn’t sound too theoretical or New Age, but the fact is that we are not—or certainly don’t need to be—victims of the DSM, pharmaceutical companies, insurers, or even each other. In a very practical way, remembering this can help us recapture our own sense of personal power. And from that, anything is possible.

Jeanette Bartha

April 9, 2013 at 10:32 am

Too many professionals and laypersons look to the DSM for guidance and erroneously think this book ‘proves’ their diagnosis is real as is the case for Dissociative Identity Disorder formerly multiple personalities.

This publication can give a child an insurance code for billing purposes that will follow them through their lives.

Richard Rolison

April 12, 2013 at 12:49 pm

While there are merits to the critique and the posted comments I wonder as to the actual process by which these diagnosis will in fact be practiced in the real world. Though based upon research(theoretically) the real world is not reproducable in the laboratory. Most of these diagnosis will be applied in a subjecttive manner by both experienced and new therapists, psychologists and psychiatrists. The amount of individual testing to confirm the diagnosis will be minimal if present at all. And yes, drug companies have a special interest here as do practitioners. However, I fear that we are making mental illnes a common condition, experienced by everyone, and therefore we are all in need of treatment.
A realistic view of the world is that life is not fair, and yes many people are in need of services and help. But to take away the most common experiences of human life, such as aging or grief, and lump it in with a diagnosable condition is at best irresponsible. A child diagnosed under this new DSM could potentially be cutoff from constitutional rights that most of us today enjoy. And what about the long term harm such a label will bring to the individual and the biological impact of unnessessary medications at such a young age.
Common framework for healthcare profesisonals, sure, standardized psychological measures, sure, making mental illness commonplace and easy, no. There are no guarantees in life nor is it fair, it is what we make of it given the hand that we are dealt.

Nate Watkins

April 15, 2013 at 10:57 am

please sign this if you’re against this bogus manual’s changes to autism/aspergers/pdd-nos: