It’s no secret that rates of psychiatric conditions like autism and attention-deficit disorder have spiraled upward in recent years -- increases that have sparked an intense debate about where to draw the line between what’s considered “normal” behavior and what’s not. The American Psychiatric Association is in charge of drawing these lines, and its latest effort to do so - the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5 - is scheduled to be published in April.
The book isn’t even out and already a backlash has begun: some experts who have seen the recently finalized text are charging that this new version of “the bible” of psychiatric disorders goes too far in prescribing psychiatric treatment for ostensibly normal human behavior.
Writing earlier this month in Psychology Today, Allen Frances argues that the DSM-5 creates psychiatric conditions where none really exist. Frances chaired the committee that oversaw production of the book’s previous edition, the DSM-IV (released in 1994), and in his article he outlines what he takes to be the “ten most potentially harmful changes” in the DSM-5. These include the creation of categories that reinterpret behaviors like grief, excessive eating, and forgetfulness as psychiatric disorders. He worries, echoing a critique made by the British Psychological Society of a draft of the DSM-5 in 2011, that this expansion of psychiatric diagnoses may lead people away from the kinds of help they really need:
Normal grief will become Major Depressive Disorder, thus medicalizing and trivializing our expectable and necessary emotional reactions to the loss of a loved one and substituting pills and superficial medical rituals for the deep consolations of family, friends, religion, and the resiliency that comes with time and the acceptance of the limitations of life.
The growing purview of the DSM invites conspiracy theories—that committee members, many of whom have industry ties, are in cahoots with pharmaceutical companies to sell more drugs. Frances rejects this idea and instead proposes a subtler explanation for why the DSM—which is nearly 10 times as long today as it was when it was first published in 1952—expands with every revision.
“Theirs is an intellectual, not financial, conflict of interest,” he writes, “that results from the natural tendency of highly specialized experts to over value their pet ideas, to want to expand their own areas of research interest.”
Or, put another way: Over-Eagerness-to-Apply-Your-Professional-Perspective Disorder.
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Leon Neyfakh is the staff writer for Ideas. Amanda Katz is the deputy Ideas editor. Stephen Heuser is the Ideas editor.
Guest blogger Simon Waxman is Managing Editor of Boston Review and has written for WBUR, Alternet, McSweeney's, Jacobin, and others.
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Joshua Rothman is a graduate student and Teaching Fellow in the Harvard English department, and an Instructor in Public Policy at the Harvard Kennedy School of Government. He teaches novels and political writing.