The Diagnostic Statistical Manual of Mental Disorders (DSM) has generated a lot of controversy for such a seemingly dull book. However, as the debate seems to rage between psychologists and psychiatrists, who are experts on mental wellness, is there any reason for us regular folk to bother about the furore over what constitutes a mental health “condition”? For Mary O’Hara, a social affairs writer and Alistair Cooke Fulbright Scholar 2009/2010, the simple answer is yes.
According to O’Hara, ‘For a start, esoteric debates about what mental illness is, and whether it is a result of biological or cultural triggers, are unlikely to be at the top of most people’s “pay attention” list. However, for people with a mental health diagnosis, the DSM and its consequences are far from obscure. It has, for decades, been influential and regarded as the bible for doctors who deliver psychiatric diagnoses.’
Not only does the DSM manual influence what clinical treatment you receive to improve your mental wellness – and, believe me, its influence is huge – the DSM also an impact on how you are labelled, or stigmatised, by wider society for your mental health condition. Until 1973, for instance, homosexuality was deemed a treatable mental illness! Yet while the DSM has eliminated such diagnoses now, some critics believe that as the manual has expanded, and increasingly over-medicalised normal behavioural responses such as after a tragedy or bereavement.
O’Hara explains, ‘As 70% of the experts serving on the committees that decided which conditions are in or out of DSM-5 have links to pharmaceutical companies, it is hardly surprising that scepticism abounds. With each edition of the DSM, new conditions are added, with some attracting opprobrium. Among those added in DSM-5 is “hoarding disorder”, defined as “persistent difficulty discarding or parting with possessions, regardless of actual value”. If new and extra conditions are becoming accepted so readily within psychiatric circles, shouldn’t we at the very least explore this trend?’
She adds, ‘When it comes to mental health, the diagnostic labels matters far beyond their clinical applications. A diagnosis all too quickly becomes a label by which an individual is defined and judged, which in turn becomes a catalyst for stigma and discrimination. There is evidence from the campaign, Time to Change, and others, that, even while there are some signs of a reduction, stigma and discrimination around mental illness are devilishly entrenched – with sometimes devastating consequences for those on the receiving end.’