February 12, 2010--The Statistical Manual of Mental Disorders
One would think it unlikely that the fifth edition of the Statistical Manual of Mental Disorders would ignite much controversy. Sarah Plain’s Going Rogue is not in any danger of being bumped off the best sellers list.
If you haven’t had a chance yet to work your way through the fourth edition—I know, I know, it came out 10 years ago and you’ve been busy—allow me to remind you that the Manual is the one authoritative place where every conceivable mental disorder gets listed and described. From the various forms of schizophrenia to bipolar disorder to eating disorders to sleep disorders to, a new one for 2010, hypersexuality.
To be listed (or not listed as the case might be—more about this in a moment) is not just of academic interest. If, for example, obsessive-compulsive behavior makes it into print (it does), there are huge implications for the pharmaceutical industry—it becomes worth their while to find new drugs to treat it knowing that if O-CB is classified as an official mental disorder doctors will be able to prescribe them and insurance companies will likely reimburse patients who seek treatment and buy their drugs.
If homosexuality, as another example, were classified as a mental disorder (it isn’t but in the past, through the third edition in 1973 it was--and there are still people today who want it restored to the list), you can only imagine the justifiable clamor. Rather than being viewed as just a “normal” manifestation of human behavior, if it was still labeled “abnormal,” by this classification homosexuals would continue to be officially and formally stigmatized and in some instances, as in the past, forced into treatment.
So the Manual’s lists and classifications in effect have a virtual monopoly on defining what is normal and what isn’t. In addition to many legal implications (it is frequently referred to when lawyers mount criminal defenses based on claims of “limited mental capacity”), there are others, as the New York Times reported the other day when noting the publication of the new edition (linked below).
One important change that was fought for by advocates for more accurate diagnoses for children with behavior issues is the addition of a new listing, “temper dysregulation disorder with dysphoria.” It replaces the previous diagnosis of childhood bipolar disorder, which led to the administration of certain meds that not only didn’t work but also frequently had serious side effects. The new description sees this behavior as “behavioral” and as such calls for it to be treated behaviorally and not pharmacologically. This is a big deal as it affects hundreds of thousands of children.
There also has been on-going criticism that the list of mental disorders has a Western cultural bias. In other words, though it appears to be based on an objective approach that attempts to look closely at what constitutes human nature, it fails to do so. If the Manual purports to define what is normal and what isn’t, it is not supposed to reflect a European or American culturally-determined version of human nature but something much more universal—Human Nature writ larger. In spite of this aspiration, critics of the book’s “science” (with “science” in quotation marks since the science behind the Manual has also frequently been called into question), some assert that even the way in which it deals with “culture” gives away its bias: disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard (Western) psychiatric diagnoses are given no cultural qualification whatsoever.
And so although this is very important work--effective treatments for legitimate disorders need to be sought (and for the most part the list is benign and helpful)--it is still very complicated and in places not without error or lacks precision.
As an example of this latter point, a final comment about the new syndrome of hypersexuality. In the Manual it is described as present when “a great deal of time in consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.” Unless they provide more detail as to what constitutes “a great deal of time,” which they do not, than from my non-clinical, non-professional experience nearly all the men I know require whatever the treatment is that is suggested.
If you haven’t had a chance yet to work your way through the fourth edition—I know, I know, it came out 10 years ago and you’ve been busy—allow me to remind you that the Manual is the one authoritative place where every conceivable mental disorder gets listed and described. From the various forms of schizophrenia to bipolar disorder to eating disorders to sleep disorders to, a new one for 2010, hypersexuality.
To be listed (or not listed as the case might be—more about this in a moment) is not just of academic interest. If, for example, obsessive-compulsive behavior makes it into print (it does), there are huge implications for the pharmaceutical industry—it becomes worth their while to find new drugs to treat it knowing that if O-CB is classified as an official mental disorder doctors will be able to prescribe them and insurance companies will likely reimburse patients who seek treatment and buy their drugs.
If homosexuality, as another example, were classified as a mental disorder (it isn’t but in the past, through the third edition in 1973 it was--and there are still people today who want it restored to the list), you can only imagine the justifiable clamor. Rather than being viewed as just a “normal” manifestation of human behavior, if it was still labeled “abnormal,” by this classification homosexuals would continue to be officially and formally stigmatized and in some instances, as in the past, forced into treatment.
So the Manual’s lists and classifications in effect have a virtual monopoly on defining what is normal and what isn’t. In addition to many legal implications (it is frequently referred to when lawyers mount criminal defenses based on claims of “limited mental capacity”), there are others, as the New York Times reported the other day when noting the publication of the new edition (linked below).
One important change that was fought for by advocates for more accurate diagnoses for children with behavior issues is the addition of a new listing, “temper dysregulation disorder with dysphoria.” It replaces the previous diagnosis of childhood bipolar disorder, which led to the administration of certain meds that not only didn’t work but also frequently had serious side effects. The new description sees this behavior as “behavioral” and as such calls for it to be treated behaviorally and not pharmacologically. This is a big deal as it affects hundreds of thousands of children.
There also has been on-going criticism that the list of mental disorders has a Western cultural bias. In other words, though it appears to be based on an objective approach that attempts to look closely at what constitutes human nature, it fails to do so. If the Manual purports to define what is normal and what isn’t, it is not supposed to reflect a European or American culturally-determined version of human nature but something much more universal—Human Nature writ larger. In spite of this aspiration, critics of the book’s “science” (with “science” in quotation marks since the science behind the Manual has also frequently been called into question), some assert that even the way in which it deals with “culture” gives away its bias: disorders or concepts from non-Western or non-mainstream cultures are described as "culture-bound", whereas standard (Western) psychiatric diagnoses are given no cultural qualification whatsoever.
And so although this is very important work--effective treatments for legitimate disorders need to be sought (and for the most part the list is benign and helpful)--it is still very complicated and in places not without error or lacks precision.
As an example of this latter point, a final comment about the new syndrome of hypersexuality. In the Manual it is described as present when “a great deal of time in consumed by sexual fantasies and urges; and in planning for and engaging in sexual behavior.” Unless they provide more detail as to what constitutes “a great deal of time,” which they do not, than from my non-clinical, non-professional experience nearly all the men I know require whatever the treatment is that is suggested.
posted by Steven Zwerling at
5:57 AM
0 Comments:
Post a Comment
Subscribe to Post Comments [Atom]
<< Home