It's Not Too Late to Save Normal

[TBC: Psychiatrists and psychologists apparently have a limit to how much folly and delusion will be accepted as “medical science.” The following comments after the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) are instructive.]

It's not too late to save 'normal' [Excerpts]

Psychiatry's latest DSM goes too far in creating new mental disorders.

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day -- despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

What are some of the most egregious invasions of normality suggested for DSM-V? "Binge eating disorder" is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) "Minor neurocognitive disorder" would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as "major depression." "Mixed anxiety depression" is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

A new category for temper problems could wind up capturing kids with normal tantrums. "Autistic spectrum disorder" probably would expand to encompass every eccentricity. Binge drinkers would be labeled addicts and "behavioral addiction" would be recognized. (If we have "pathological gambling," can addiction to the Internet be far behind?)

The sexual disorders section is particularly adventurous. "Hypersexuality

disorder" would bring great comfort to philanderers wishing to hide the motivation for their exploits behind a psychiatric excuse. "Paraphilic coercive disorder" introduces the novel and dangerous idea that rapists merit a diagnosis of mental disorder if they get special sexual excitement from raping.

Defining the elusive line between mental disorder and normality is not simply a scientific question that can be left in the hands of the experts. The scientific literature is usually limited, never easy to generalize to the real world and always subject to differing interpretations.

http://www.latimes.com/news/printedition/opinion/la-oe-frances1-2010mar01,0,3405767.story

(Frances, LA Times Online, 3/1/10).