In a month’s time, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is due to hit psychiatrists’ and psychologists’ shelves. This is a standardised system of diagnosing mental disorders produced by the American Psychiatric Association (APA), but the DSM is not without its critics. The first edition of the DSM was published in 1952, and there have been three more since then, coming out every 15 to 20 years. However, the DSM has always had opposition, as some object to classifying mental health, as this can have several wellness complications.
The DSM-5’s primary purpose is to allow a reliable diagnosis of a mental disorder, as well as providing treatment pathways and likely outcomes for a patient’s wellbeing. Certainly, mental health is more difficult to measure than, say, heart health, but without the DSM-5 there is no other way of truly knowing whether a disease really exists. Differences of opinion are inevitable in this area, and so the DSM enables two clinicians to reach the same diagnosis for a particular patient.
As the APA has made a lot of money from the DSM “enterprise”, critics argue that the DSM is just a money-making scheme in which book royalties are the primary motivator for producing yet another edition. However, if book royalties are the primary objective, how would you explain that an estimated $25 million has already been spent on the fifth revision process? The truth is, medical experts are continually learning about the brain and mental health, and so revisiting standards and guidelines every 20 years is hardly an unnecessary step to take.
One of the main worries about the latest DSM is that more people will be diagnosed with a mental disorder. Though the total number of disorders in DSM-5 is yet to be announced, its chair David Kupfer has said the total number of disorders will not be more than in the DSM-IV: 297. Revising the DSM is an extremely rigorous process, which requires strong scientific evidence and wide expert opinion before new disorders or guidelines make the cut.
Finally, critics assert that the DSM is trying to redefine what’s normal. Yet being normal is not the same as “not having a DSM-5 diagnosis”, and having such a diagnosis is not the same as being “insane”. This has been wrongly argued by those who oppose the DSM, as many individuals, including physicians, find it difficult to accept that mental illness, not unlike physical illness, is common and most of it is not madness or insanity. The DSM is definitely not above criticism, but is probably the best manual of mental disorders that we are likely to have for some time.
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