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Debunking the DSM: You're messed up, but are you sick?'


Regular doctors have their diagnostic codes, so psychiatrists must have them, too. It's called the Diagnostic and Statistical Manual of Mental Disorders (DSM for short), and a retired British doc says the profession shouldn't be so quick to use it to explain patients' problems. 

Psychiatrists find the DSM useful because it gives them scientific-sounding illnesses with codes for billing insurers; something mental health professionals will be able to do more of under the Affordable Care Act, which requires insurers to cover mental and physical health needs equally.

But some of the DSM diagnoses have a preposterous ring, the author says. One that was proposed but never made it into the books was "Masochistic personality disorder," involving "self-sacrifice in the service of maintaining relationships or self-esteem." An outcry from feminists stopped it from becoming a sweeping term for any woman putting up with an abusive boyfriend. 

The boyfriend, on the other hand, could have "Intermittent explosive disorder" according to the DSM, provided he's had "three violent and unpremeditated outbursts in a 12-month period in which people or animals were hurt."  

Pushing her around just to intimidate her? Messed up, but not sick, the DSM says. 

The diagnostic codes point up the vulnerability of the psychiatric profession to claims that it's not "scientific" enough and can't quantify its mental health results. Pushing back against the American Psychiatric Association which stands behind the DSM, the author suggests it institutionalizes a "lack of common sense, the quality that psychiatrists, perhaps more than any other kind of doctor, need." Read the opinion.  


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