It’s hard to believe that it has been a year already since I first wrote about the DSM (the Diagnostic and Statistical Manual of Mental Disorders) in a post called “What It Is and Why You Should Care.” The diagnostic criteria for the fifth edition were just approved by the American Psychological Association (APA) Board of Trustees this past weekend, in preparation for this edition’s publication in May 2013.
In my earlier post, I expressed concern over the growth in the list of diagnoses that appeared with each new edition of the DSM, and whether there was a correlation to the overall growth in mental illness diagnosis and medication treatment. Obviously, that’s a pretty tough case to make, but it did generate some really great conversation in the blog post’s comments. There are other folks out there besides me who are worried that the DSM’s evolution is having a trickle-down effect, the outcome being a society prone to over-medicate people who are experiencing normal emotions, e.g. the temper tantrums of a child, bereavement grief, etc.
Unfortunately, the DSM-5 diagnostic criteria were approved in pretty much the same state as they were when these concerns were raised in 2011 and earlier. One of the most vocal opponents of the content of the DSM-5 changes has been Allen Frances, a psychiatrist and the Chair of the DSM-IV Task Force. Of this most recent edition, he had this to say, “”Except for autism, all the DSM-5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation.”
As a result of the rich conversations about mental illness I’ve had with readers in the past year, I endeavor to approach a potential diagnoses predicament with the following in mind:
- Like real estate agents, of the many psychiatrists out there, some are much better at their profession than others
- Most (if not all) psychiatrists genuinely want to help and improve their patient’s situation. They are not all on the payroll of big pharma.
- Sometimes it is a flawed system that forces a practitioner into making a diagnosis (in order for the visit to be covered by medical insurance)
- In severe cases of mental distress, the use of medication for treatment can be necessary in order to return a patient to a state of mind where they have any chance of benefiting from other treatment modalities. And of course, for some, medication is the best treatment modality, period.
That said, I’m going to add some reasonably reasonable statements:
- Never underestimate the power of a good support network, e.g. friends, family, a consistent health team
- Talk to more than one practitioner. Notice that in the point above, I referred to a health team.
- If you or family members are dealing with chronic mental health issues, if possible, try to maintain a relationship with a practitioner that has been along for the whole ride
- In her memoir Changing My Mind, Margaret Trudeau wrote of the importance of a person with a mental illness having a life-long advocate. It could be a friend, family member, or practitioner; the important thing is that there’s someone who really understands the issues and how the patient has responded over time. Often, medical records and information don’t travel with the patient and each new practitioner must ‘start from scratch.’
If you’d like to read more about the DSM-5 changes and the discussion around them, here is an article called Experts React to DSM-5 Approval. Allen Frances also wrote several response pieces that have been published this week, including this one on The Huffington Post called DSM-5 is a Guide, Not a Bible.
Are the evolution of the DSM and the changes in its forthcoming edition of concern to you? Or am I overstating the impact of the DSM on our society with regard to how it shapes diagnoses and treatment?
Jagoda says
I agree with your points, Laura. Years ago, I volunteered at a rape crisis center where, in addition to counseling survivors, I also trained new volunteers. We included DSM nomenclature in our training to familiarize staff so they would understand mental health professionals if they accompanied one of their clients to the hospital. I recall one trainee who became very angry about the “labeling” and its potential abuses, and how such diagnoses can make life harder for a survivor.
With respect to the insurance coverage, I have personal experience with that. My therapist had to search to find a diagnoses that would enable coverage, when I clearly didn’t fit. In any case, your thoughtful approach is just what the doctor (should have) ordered.
Laura Zera says
Jagoda, welcome, and thank you for sharing your experiences. Yes, the ‘labels’ can have a powerful impact, especially because they often are coming from someone who is seen as the expert. I vividly remember how I felt when I was given a diagnosis for agoraphobia in 1991 — awful, damaged, bewildered, etc. Luckily, I didn’t put much stock in the views of the practitioner and I moved through the issues that were causing the panic attacks. But man oh man, a diagnosis can start a lot of wheels turning in the person’s head who’s on the receiving end.
Jeri says
It’s so important how you point out to see more than just one practitioner. Whether dealing with real estate agents, doctors, or teachers, all professionals are not created equal.
Laura Zera says
No, and although it can be exhausting to get second opinions and to try to coordinate professionals into a cohesive care team (because they often don’t coordinate themselves!) it’s part of the whole ‘self-advocacy’ thing…
Jo-Anne Teaal says
I agree wholeheartedly with your excellent points, Laura. In particular, the highlight of M.Trudeau’s mention of an advocate, or some might say ‘care partner’.
Another thought provoking post, my friend.
Laura Zera says
Care partner is a nice way of putting it, too. Thanks for reading, Jo-Anne.
Jodi from Heal Now and Forever says
I read it referred to as a “bible,” and I was thinking about everything awful people did in the name of the bible like the witch hunts, and the Spanish Inquisition. I use diagnosis to get health insurance but 99% use Adjustment Disorder. I hate that it is called a disorder. We are all adjusting all of the time. Sometimes I must switch to an organic diagnosis since adjustment disorder won’t cover more than 6 months of counseling. But while people know I have to do this for their insurance I speak to them about how subjective a diagnosis is and help them sort what is means (when given by someone else.)
Laura Zera says
It’s really interesting to hear this input from a practitioner’s perspective, and I love that you talk to people about “diagnosis” and not just “THE diagnosis.” And I didn’t even know that there was a listing for Adjustment Disorder. That does seem a bit like an oxymoron, doesn’t it?