Manipulation of the DSM-5: Robin S. Rosenberg, Clinical Psychologist

Abnormal Is the New Normal

Why will half of the U.S. population have a diagnosable mental disorder?

By Robin S. Rosenberg, a clinical psychologist in San Francisco and the author of Superhero Origins and Abnormal Psychology. Edited for length; bold my emphasis. Full article can be read in SLATE, Medical Examiner section, 4/12/13. 

In addition to classifying some medical disorders as mental disorders, the DSM also has been nibbling at the edges of “normal” by reclassifying as pathological the patterns of thoughts, feelings, or behaviors that were previously considered normal (albeit perhaps weird or odd). For instance, people who are extremely shy and concerned about how others might evaluate them, and who thus avoid certain types of activities, might be diagnosed with “avoidant personality disorder.” These same characteristics didn’t used to be considered pathological, and in some other cultures they are not considered to be so.

Another way that the increased prevalence of mental illness occurs is by lowering the threshold of what it takes to be diagnosed with a given disorder. For instance, DSM-5 will change in the criteria for “generalized anxiety disorder,” a disorder that involves excessive and persistent worrying. Whereas the criteria in DSM-IV required three out of six symptoms of worrying, only one symptom is needed in DSM-5. Similarly, whereas in DSM-IV the symptoms must have persisted for at least six months, in DSM-5 the duration has been reduced to three months.

One effect of a bigger mental illness tent is that there are fewer people standing outside the tent. Although the next edition of the DSM might not increase the overall number of disorders, if the criteria are loosened…then more people would qualify for a disorder. There are, and probably will continue to be, fewer and fewer people who will live their lives in relatively good mental health according to the DSM.

The normal trials and tribulations of life—the periods of sadness, or worry, of anxiety, or grief, of difficulty sleeping, of drinking too much caffeine or having caffeine withdrawal headaches—have been pathologized. They’ve been made into mental illnesses… providing a bigger tent for mental illness leaves us with an increasingly restricted definition of mental health and can make us all more likely to see mental illness even when it isn’t there—where there is just normal human struggle. We can become so used to seeing psychopathology that we think—erroneously—that being odd or having difficulties must be an expression of mental illness.

What is going in our culture that allows for this expanding definition of mental illness? There are many explanations. The first is related to payment for treatment. Psychological treatments and medications can be useful for a variety of problems, but for those treatments to be even partially paid for by health insurance companies, the problems must have a diagnosis. It’s not enough that there’s a problem that’s being addressed. It has to be a problem. (Of course, if you treat a problem before it becomes a mental illness, the health insurance company will have ended up saving a significant amount of money, but they don’t pay for early mental health intervention—there has to be a problem. But that’s a story beyond the scope of this article.)

Second, pharmaceutical companies search for ever-wider markets for their products. When more people are diagnosed with a given disorder (perhaps because of less stringent criteria), or a new diagnosis is created, it widens the market for their drugs. They push for “off-label” uses of their medications that in some way reduce a problem, and then they push for that “problem” to be redefined as a problem.

In fact, DSM-5 and the pharmaceutical industry have a significant number of connections: One study found that 70 percent of DSM-5 task-force members have financial ties to the pharmaceutical industry.

Anyone who maintains that the diagnosis put forth in the DSM are science-based is CRAZY...

In a crazy world, sanity must be earned.