The long-brewing debate over the accuracy of the psychiatry profession’s bible, called the Diagnostic and Statistical Manual (DSM) of Mental Disorders, came to a head this week as the American Psychiatric Association released the sixth edition of the 900-page book and disclosed that 100 percent of Americans are now classified as having a mental disorder.
“We feared this was going to happen,” says Jim Dulaney, professor emeritus at Columbia University and chair of the American Psychiatric Association. “Every time we update the DSM, more Americans fall under one of its disorders. Now we’re at the point where all Americans fall under one of its disorders, so we either have to reevaluate how we define mental illness in this country or we’re all really sick.”
How disorders get added to the book has always been something of a mystery. Past members of the DSM committee are reluctant to talk about the process, and indeed are subject to non-disclose agreements, but over the years information about how the work is done has leaked out. Based on this information, the process works like this: A committee member comes up with an idea and after the members talk about it, often over lunch, they have a vote. If more committee members think the disorder should be included than don’t, the disorder is included. The whole process takes about an hour, unless the disorder is complicated. Then it might take an hour and 15 minutes.
One former committee member, who asked not to be identified, says the process isn’t perfect, but “it’s a lot better than going the scientific route, because you can’t do science in an hour,” this person says. “Whereas this way, we can just make up disorders that kind of seem right and get them added in before we finish our tuna sandwiches. It’s a very satisfying feeling knowing you’ve added a mental disorder to the official psychiatric disorder manual. I’ve had a couple included myself, which I think is really neat. Inappropriate Sexual Thoughts Disorder (ISTD) is one of mine. It just came to me the night before our meeting. I guess other committee members have experienced it, too.”
Whatever the actual process, there’s no question about the importance of the DSM to the medical community, since it determines what behaviors are considered disorders and whether psychiatrists can prescribe drugs to alleviate the symptoms. “It’s easy to pass off certain behaviors as normal,” says Susan Ellerton, a professor of clinical psychiatry at the University of Southern California. “The role of the DSM is to say, ‘No, just because most people do it and have always done it, that doesn’t make it normal.’ Boys getting antsy sitting in a classroom conjugating verbs have Attention Deficit Hyperactivity Disorder (ADHD). Girls going through a period in which they think they’re too fat have Negative Body Image Disorder (NBID). Many people think these are just normal phases of growing up, but we’ve had specialists talk about these behaviors for at least an hour, so we know they’re actually medical disorders.”
Among the new disorders included in the sixth edition are Smartphone Distraction Syndrome (SDS), Afternoon Work Drowsiness Condition (AWDC), and New Apple Device Anxiety Disorder (NADAD).
The DSM has its skeptics. “I get anxious myself when Apple comes out with an update to its iPhone, but should I be medicated for that?” says Nathan Creighton, a psychiatrist in Binghamton, N.Y. “A million people are diagnosed with that disorder now. This is ridiculous, especially since Samsung has the more popular phone today. No doubt in the next edition of the DSM, there will be a Samsung variant on the disorder.”
Creighton is incorrect about that. The Samsung version is already in the DSM, on page 783, next to Wearable Technology Sending Instructions to My Brain Disorder (WTSIMBD).
This is a work of satire. It is fictional news article not meant to be taken seriously. Photos: jhm (Creative Commons). Not necessarily an endorsed use of images.
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