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DSM: Diagnosing for Status and Money

A Critical Look at the DSM & the Economic Forces That Shape It

Clinical Update
By Zur Institute

View a complete list of Clinical Updates.

 

In principal, mental health diagnoses can be helpful to clinicians and researchers in their formulation of treatment, research and communication with other professionals.  Unfortunately, the DSM has been shaped by economic and political influences rather than by scientific and medical ones. The DSM assigns diagnoses in a biased manner, resulting in more harm than good to our patients, their families and society at large while delivering huge profits to pharmaceutical companies. Women, children, minorities, lower income and older people are the groups most likely to be negatively affected by the biases presented in the DSM.

DSM Recap:

  • The DSM has been called the billing bible of psychiatry and has become one of the most influential texts in the field of mental health.
  • The DSM is a powerful tool of social control: its criteria are used to judge who is normal or abnormal, sane or insane or who should remain free or be hospitalized against their will.
  • Most texts and graduate and postgraduate courses present the DSM as an objective, scientific document. It is neither.

  • The DSM is primarily driven by the psychopharmacological industry, which reaps huge profits from each new diagnosis that can be treated with medication.
  • The frame of the DSM is distorted by a primarily intra-psychic-individual focus and tends to ignore contextual factors. It does not address what cannot be solved with a pill. It does not appropriately address patients who, in fact, are wrestling with social problems, such as sexism, racism, or homophobia, or existential anxieties regarding loneliness or death. Unfortunately, using the DSM, the dis-ease of such patients will be redefined as medically treatable maladies.
  • The DSM perpetuates the myth that the medical-mechanistic model can simply be applied to psychology.
  • Some clinicians have used the DSM categories as a form of "name calling". Accordingly, the DSM gives some therapists an illusory feeling of power and superiority driven by the "power to name".
  • DSM-based research has repeatedly been shown to be of questionable validity and is, in fact, very unreliable.
  • Since its inception in 1952, the DSM has consistently viewed pathology as residing within the individual.  Subsequent revisions in 1980 and 1987 have evolved toward a more firmly biological perspective.
  • In response to insurance companies' need for increasing specificity in diagnoses and the psychopharmacology industry's need for new markets, the number of available diagnostic labels rose from 297 in 1994 to 374 in 2000. The upcoming DSM V is likely to include hundreds more "new" (and profitable) mental disorders.
  • DSM is big business, not only for its publisher, the American Psychiatric Association, but even more so for the psychopharmacological industry, which profits from prescriptions written for the ever-increasing numbers of DSM disorders.

 

DSM pathologizes many normal and healthy behaviors:

  • Shyness: You are mentally ill if you are very introverted or extremely shy.
  • Grief: God forbid if you intensely grieve the loss of a beloved one for more than six months.
  • Depression: You must be mentally ill if you respond to real life issues or injustices with deep sadness and intense despair.
  • Anxiety: You must be mentally ill if your reaction to the existential reality of mortality or loneliness involves profound or debilitating anxiety. (For more, see our online course: Anxiety.)
  • Lack of Sexual Interest:  Lack of sexual interest is often not a mental disorder. Many women may have good reasons to avoid sex that may stem from domestic abuse, overwork or other reasons. Kaschak and Tiefer (2001) discussed Female Sexual Dysfunction (FSD) as "a textbook case of disease mongering by the pharmaceutical industry..." or what they call the "medicalization industry."
  • Spirited Children: DSM casts a very broad net around the ADHD diagnosis, and often includes millions of spirited, strong-willed, and highly gifted and creative children. It results in huge profits for medicating psychiatrists and pharmaceutical companies. (For more, see our online course: AD/HD: An Overview Of Current Perspectives.)

 

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