Difficulties, Diagnoses, the DSM. | Petar Sardelich, LMFT/PT/MAC, Therapist in Pasadena, CA 91101

In a New York Times Op-Ed piece from today, one of the leads on the DSM-IV (the "Diagnostic and Statistical Manual", the current edition of an industry standard tool for mental health, primer here) task force wrote about the upcoming changes in the DSM-V (likely to be released in early 2013). Summarizing, Allen was suggesting in part, "...after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription.", and that the American Psychiatric Association was arguably no longer in a place to be singularly in charge of the meting out of diagnoses, calling it a "monopoly" (offering that an agency akin to the FDA or National Institute on Mental Health might be examples of ways to provide oversight in the efforts to insure some science around diagnosing emotional and mental problems).

Am with Allen on quite a bit of this. What comes to me often too, is that we have equally large fish to fry with the DSM and the profession than just the pathologizing and monopolizing he suggests. We have been over-diagnosing ADHD (attention deficit hyperactivity disorder) and bipolar disorder, among others. Our differential diagnosis (rationalizing one diagnosis vs another) has also been resulting in much harm to people by way of treating issues unneeded, and/or incorrectly. We are also arguably guilty as a discipline of using interventions that are more "intrusive" than necessary (for instance, medicating a problem before efforts at traditional talk therapy and/or other interventions have yet to be tried).

It seems to me that in reviewing the DSM, we are more currently in need of insuring the accuracy and value of our diagnoses, in terms of insuring that those so suffering are treated more appropriately. We do know ways to treat depression, anxiety, addictions, bipolar disorders and etc. We do have means of helping people through grief/loss, communication problems, abuse, suffering with stress and etc. As the saying goes though, the "cure" (a dubious word to begin with) is only as good as the diagnosis, and with the numbers of the diagnosed only increasing in the US year after year, either our diagnosing or treatment (or maybe a bit of both) are not faring as well as they might.

A quick aside here- not all of the missed treatment opportunities are about the above issues. Some of them are due to the influence of Big Pharma (an intense imposition by the pharmaceutical industry), access and funding of mental health treatment, the insurance industry and more.

Specifically related to the DSM though, my hope is that we'd simply be better at a lot of the material we already have. Adding diagnoses, or simply separating them into finer and finer constellations of symptoms seems both unnecessary and unhelpful, philosophically speaking. Part of what I'm getting at above is that I think we have some good ideas about how to help many ills- I just wish we spent more time treating them, and less time diagnosing new ones.

You can find out more about Petar at: http://www.april30th.org