Despite how it might seem lately, mental health diagnosis in this country is not controlled by life coaches on TikTok. Rather, an 11-year-old controversial "bible" calls the shots and decides, for example, whether your attention issues are from a screen addiction or a developmental disorder called ADHD. Released in May 2013, after years of in-fighting within the psychiatric community, the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition," was immediately controversial and dismissed by some as unscientific. The National Institute of Mental Health refused to fund research based on its criteria, with the center's director Thomas Insel claiming the field needed to "reorient" away from the DSM's symptom-based categories.
Writer and psychotherapist Gary Greenberg interviewed Insel for this week's Classics, "Inside the Battle to Define Mental Illness." Published in WIRED's January 2011 issue in the middle of the creation of the DSM-5, Greenberg's story follows Allen Frances, a key figure behind the manual's predecessor, the DSM-IV, who had turned his back on the enterprise entirely. Frances summarizes his opinion in conversation with Greenberg: "there is no definition of a mental disorder. It's bullshit. I mean, you just can't define it." While detailing Frances's battle against the book's publisher, the American Psychiatric Association, Greenberg reflects on the role of the pharmaceutical industry and the purpose of nomenclature to categorize and pathologize human suffering. In doing so, he questions the basis of psychiatry itself and the nature of the human condition.
Thirteen years after Greenberg's piece and despite all the contention outlined in it, the DSM-5 is still the gold standard in psychiatry. The questions Greenberg and Frances ask are as relevant as ever, and prompt even further interrogation. Of course, the diagnosis and treatment of mental health conditions improves and even saves innumerable lives, and the value of that can't be overestimated. Still, one in five Americans suffer a DSM-5-categorized disorder, while the conditions around us only worsen. Misfortunes such as isolating, deadly pandemics, displacement from climate change, and screen addictions spurred by insidious algorithms are rewiring our brains and affecting our mental health as I write this. I wonder, how well does it serve us to turn to a book and rigid criteria to pathologize our pain? Let me know what you think in the comments below the article, or send me an email.
Until next week,
Sam
.jpg "Collage of yellow DSM cover mock-up; close-up of a person's hands who is picking at their fingers; circle of adults participating in group therapy")
.jpg "reflection of people walking")
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