Considered the bible of the mental health profession, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, sets the criteria for distinguishing mental illness from normality, often determining who is sick, what treatment is offered, who pays for it, etc.
But determining what is “normal” is a relatively subjective undertaking that is influenced not only by science, but also by shifting societal pressures. From 1952 to 1973, the DSM classified homosexuality as a mental illness. While I often use the DSM as a guideline for understanding and treating my clients, I am also acutely aware of its limitations.
I was intrigued when I learned that the psychiatrist who led the group of mental health professionals who created the DSM-IV had become the leading critic of the new DSM-V, published last month.
Allen Frances, M.D., came out of retirement to speak out against a series of new diagnoses he believes are over-pathologizing the human condition. I interviewed him about his new book, “Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life.”
What you mean by “saving normal”?
Every individual experiences psychiatric symptoms from time to time. The new DSM turns grief into Major Depressive Disorder, worrying about cancer into Somatic Symptom Disorder, temper tantrums into Mood Dysregulation Disorder — and anyone might qualify for Attention Deficit Disorder, especially because it gives legal access to stimulant drugs.
Why does normal need saving?
People who have severe symptoms need urgent diagnosis and treatment. These people are usually being undertreated, while people with problems with everyday life are being overtreated with medication — when they could just as easily benefit from psychotherapy. Twenty-five percent of the American population would now qualify for psychiatric diagnosis, and 1 in every 5 is taking a psychiatric pill. This is often done after a very brief visit with a non-psychiatrist.
What would you suggest people do to prevent this?
People should take as much care when they “buy” a psychiatric diagnosis as when they buy a house or car. Always go to a psychiatrist for a mental health evaluation. If the diagnosis seems to fit, ask lots of questions. If you don’t get reasonable answers, get a second or third opinion. Kids are especially hard to diagnose, and often, problems will resolve on their own. Diagnosis should also be done over several weeks to see how things evolve. Most problems get better without pills, which should be reserved for severe symptoms that are causing marked impairment.
What would be the most important first step?
Preventing the drug companies from advertising to consumers, which is legal only in the United States. The drug companies use slick and misleading marketing techniques to convince people that problems of everyday life are mental disorders due to a chemical imbalance and requiring a pill solution. Mental illness shouldn’t be pedaled like cars and beer.
— Kim Schneiderman, MSW, LCSW, is a psychotherapist and former journalist with a private
practice in New York City. This column is not intended to be used as a substitute for a private consultation with a mental health professional, nor is this therapist to be held liable for any actions taken as a result of this column. If you have any concerns related to the content of this column, please make an appointment with a licensed mental health professional. E-mail Kim your questions at firstname.lastname@example.org.