DSM

Criticism of America's Diagnostic Bible - The DSM [Excerpts]

The most common, widely used and nearly mandatory diagnostic system in the United States is the Diagnostic and Statistical Manual of Mental Disorders (commonly referred to as the DSM). The DSM is published and controlled by the American Psychiatric Association (APA) and has been promoted by the APA as a technological triumph that is based on data and science. The American Psychiatric Association is not the same organization as American Psychological Association (also known as the APA). 

The organization and the structure of the DSM present an image of precise and exacting criteria that can be used to formulate the diagnosis of a mental disorder. This level of precision and the criteria have persuaded many professionals to conclude (without critical evaluation) that the DSM identifies and describes clear and distinct disorders and does so in a manner that is useful and beneficial to professionals and consumers. 

Unfortunately there does not appear to be any clearly useful relationship between the DSM diagnosis, treatment and the outcome of treatment. For all the apparent precision and reliability, the DSM diagnostic system minimizes one important fact. The DSM was not constructed scientifically but is based on a consensus building process that is highly political, partially democratic and even resistant to scientific evidence. The mere fact that any diagnostic system is reliable does not mean the process is valid, useful and not harmful. 

The diagnostic process employed by the DSM is nowhere near the quality and sophistication of the diagnostic process in medicine -- and many physicians argue that the medical diagnostic process is not sufficiently reliable or valid. And while there are similar diagnostic processes in medicine, most medical diagnoses are at least based on objective findings and scientific methods. For example, the diagnoses of the various forms of cancer are based on the observation of distinct physical structures and biochemistry that vary. The diagnosis of pneumonia is based on a bacterial or viral agent of which each have fairly distinct symptoms, histories and responsiveness to treatment. Hypertension is identifiable based on numerical measures of blood pressure and deviation from a numerical norm. 

There are only a few areas in medical diagnosis that are based purely on the patient's subjective complaints or vague medical terms. The overall diagnostic process employed in the DSM is not much more sophisticated than those used to reach the most general diagnosis of headache, a stomach ache or inner ear problems. . . . 

Other issues created by the use of DSM are more subtle, but they are real and they are important. For one thing, some professionals are losing sight of the patient as human being. They are also losing site of the diagnostic labels and the impact on patient rights and the risks associated with using health insurance.  Professionals can become involved in a diagnostic process that does little more than expose consumers to significant risk in order to generate an authorization for payment from a managed care company (Michael G. Conner, http://www.oregoncounseling.org/Diagnosis/CriticismOfDSM.htm).