There’s a reason that the Diagnostic and Statistical Manual of Mental Disorders – better known as the DSM – is often referred to as the “psychiatric bible.” Not only does it shape our understanding of mental health, it has major real-life implications for things like health insurance: Doctors and psychologists use the diagnoses enumerated in the DSM for billing purposes. It affects which children get access to social services and can influence legal disputes between parents in a court of law.
That’s why when it gets revised by the American Psychiatric Association, people inside and outside the profession take notice. A This American Life episode from 2002 by Alix Spiegel recounting the story behind the APA’s 1973 decision to exclude homosexuality from the DSM-II’s definition of sexual deviance illustrates the power of the manual and drama that can ensue when it’s changed. (The APA, in the spirit of modernity, ditched Roman numerals in favor of the more commonplace Arabic for the latest iteration.)
Although the DSM-5 is not expected to come out for another year, it’s been drumming up all kinds of controversy since 2008. Next month, activists plan to stage an “Occupy the APA” protest in Philadelphia during the organization’s annual conference to show their disdain.
Opponents slam both the process and substance of the DSM-5. Ironically, the man in charge of the DSM-III, Robert Spitzer, has accused the APA of not being transparent enough about its decision-making process.
Christopher Lane, a Northwestern University professor and a columnist for Psychology Today, says the new DSM is naturally suspect because of the APA’s longtime coziness with the pharmaceutical industry. He says the psychiatric community’s embrace of anti-depressants in the 1990s is a direct result of its ties to companies like Eli Lilly, the manufacturer of Prozac.
According to Lane, rather than making positive changes, the fifth edition stigmatizes human behaviors and emotions. He’s especially concerned about a modification that would enable a grieving person to be diagnosed with depression as soon as two weeks after the death of a loved one.
Dr. Maria Caserta, the medical director of inpatient care at UIC’s Department of Psychiatry, shares Lane’s concerns about what’s known as the “bereavement exception” but thinks that psychiatrists have become more aware of potential conflicts of interest with drug companies. To avoid impropriety, UIC no longer allows drug company reps inside their walls.
The substantive change that’s gotten the most media attention is the removal of Asperger’s from the list of autism spectrum disorders. For many people with the diagnosis, Asperger’s has become a central part of their identity and a source of community. Steven Migalski, a clinical psychologist in Chicago and a professor at the Adler School of Psychology, says a lot of his patients with Asperger’s feel disenfranchised. As a clinician, he feels it’s his responsibility to show compassion and respect while explaining how the changes will affect their day-to-day lives.
On today’s Eight Forty-Eight, Lane, Caserta and Migalski will share their thoughts on the DSM-5. To join the conversation, call 312.923.9239.