There’s an interesting article in the NY Times Sunday review. You can see it here. It was written by Sally Satel MD, a psychiatrist, currently a resident scholar at the American Enterprise Institute.
The article is called: “Why the Fuss Over the DSM-5?” Dr. Satel’s central point is that psychiatrists only treat symptoms anyway and pay little attention to the DSM. She expresses the belief that the manual’s diagnoses are “…passports to insurance coverage, the keys to special education and behavioral services in school and the tickets to disability benefits.”
Dr. Satel acknowledges that “…the DSM generally affords physicians enough leeway to shoehorn patients into some kind of diagnostic cubby for billing purposes…,” but insists that the manual has little bearing on actual psychiatric practice. She laments the fact that DSM has created an environment in which a great many people are consigned to disability status, but attributes the responsibility for this state of affairs to “…insurance companies, state and government agencies, and even the courts….,” all of whom will, she tells us, “…continue to imbue the DSM with a precision and an authority it does not have.”
The article is interesting in its own right, and many of Dr. Satel’s criticisms of DSM are familiar to those of us on this side of the debate.
But the real dynamic here, in my view, is a strong desire in many psychiatric quarters to distance themselves from the DSM. The run-up to DSM-5 has seen an unprecedented torrent of protest from survivors and from other helping professions. And then, just when the APA perhaps thought that things couldn’t get any worse, Thomas Insel, Director of NIMH, came out and stated that the diagnoses had no validity (here), and the Division of Clinical Psychology (part of the British Psychological Society) issued a statement calling for a rejection of the DSM and of psychiatry’s persistent medicalization of human problems (here). (Dr. Insel has since patched up his quarrel with the APA, but has not recanted the substance of his earlier criticism.)
The fact is that the DSM is an extraordinarily destructive book. Its fundamental premise, – that human problems are caused by illnesses – is meaningless. But its real damage stems from the fact that it is used to legitimize the widespread distribution of ineffective and damaging drugs, and the routine disempowerment and stigmatization of psychiatry’s customers.
Psychiatrists might not refer to it in their day-to-day work, but as a profession, they rely on its concepts to legitimize the medicalization of human problems, to establish and retain their dominance in the mental health system, and to encourage dependence and customer-for-life status among their clients.
Now the DSM is fast becoming a liability, and there’s a rush for the life-boats.
On this side of the debate, we need to recognize that, as damaging as DSM is, it is ultimately only the written codification of psychiatric destructiveness. And this destructiveness will continue unabated even as DSM is shuffled quietly to the sidelines.
We’ve won a victory, but the war continues, and people are still being destroyed.