Few books command the biblical respect and status of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, and this “objective” authority on the most subjective branch of medicine, last revised in 1994, is currently being retooled for the twenty-first century. It is a monumental undertaking. “Anything you put in that book,” Dr. Michael First, professor of psychiatry at Columbia and editor of the current version, said to the New York Times, “any little change you make has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled.”
Critical assessments of DSM’s next edition include that it will serve as a vehicle by which to sell more drugs and that it will make health insurance more difficult to obtain. It is easier to rationalize prescribing a pharmaceutical for someone with a DSM-certified problem (“hypersexual disorder,” for example, is proposed for people who suffer from an unusually high sex drive) than for someone without, just as it is easier to justify denial of coverage to someone who appears to be headed for a lifetime of expensive monthly prescriptions than for someone whose chart is diagnosis-free. Indeed, an edition of DSM chock-full of new disorders (such as “Internet addiction”) runs the risk of “massively pathologizing people,” said Dr. Jerome C. Wakefield, a professor of social work and psychiatry at New York University.
But the critics should realize that a definitive and authoritative reference is an essential tool for alleviating the pain and suffering of those who are afflicted. In the debates over the new edition, it’s easy to forget that treatment is the end goal of psychiatry. Sure, a DSM taken to its logical extreme would need to list 6.8 billion disorders, one for each nut on the planet. But going in the opposite direction, having fewer or inadequate guidelines to help professionals identify mental illnesses and the proper treatments for them, could be worse. The APA has a nearly impossible job on its hands.