Are We Really That Ill?

I meant to blog about this a few days ago, but time got away from me and here it is April already! Christopher Lane over at The (N.Y.) Sun has written an in-depth editorial asking if we Americans are as sick as some of the mental health professional experts would have us believe. It’s a legitimate question, as the number of diagnosable disorders has expanded over the years (but technically hasn’t changed since the release of the original DSM-IV in 1994, 14 years ago).

In the editorial, Lane examines why 112 new disorders were added to the DSM-III, which was originally published in 1980 (28 years ago, not that anyone is counting).

His cursory look at the complex and unscientific process that went into the DSM-III is interesting, but ultimately unsatisfying:

Incredibly, the lists of symptoms for some disorders were knocked out in minutes. The field studies used to justify their inclusion sometimes involved a single patient evaluated by the person advocating the new disease. Experts pressed for the inclusion of illnesses as questionable as “chronic undifferentiated unhappiness disorder” and “chronic complaint disorder,” whose traits included moaning about taxes, the weather, and even sports results.

Social phobia, later dubbed “social anxiety disorder,” was one of seven new anxiety disorders created in 1980. At first it struck me as a serious condition. By the 1990s experts were calling it “the disorder of the decade,” insisting that as many as one in five Americans suffers from it. Yet the complete story turned out to be rather more complicated. For starters, the specialist who in the 1960s originally recognized social anxiety – London-based Isaac Marks, a renowned expert on fear and panic – strongly resisted its inclusion in DSM-III as a separate disease category. The list of common behaviors associated with the disorder gave him pause: fear of eating alone in restaurants, avoidance of public toilets, and concern about trembling hands. By the time a revised task force added dislike of public speaking in 1987, the disorder seemed sufficiently elastic to include virtually everyone on the planet.

The fourth edition of the DSM added a great deal of scientific and formal process to the efforts of what was to be included or disincluded in its revision. Every decade adds a new wealth of knowledge to our understanding of human behavior. And we also learn the powers of things like the DSM.

At the time of its publication, the DSM-III was hailed as a scientific break-through. It opened the door to more reliable and valid diagnoses amongst mental health professionals. Before the DSM-III, mental disorders were largely subjectively diagnosed and classified into one of two groups, neurotics and psychotics. The DSM-III added a lot more nuances to such gross categorization, in recognition of our increased understanding of these problems people face. Was it a perfect categorization schema? Heck no, but it was a huge step up from the rarely used DSM-II.

Are diagnostic manuals these clean, logical processes that come together through pure research? No, and they never will be because humans put them together. In the world of the DSM and mental disorders, it’s even more challenging because the humans who put it together come from varying backgrounds with various special interests (and sometimes, self interests). Diagnosis through committee is probably not the best nor most rigorous process that could be devised, and yet it is exactly that because all interests try to be represented (and the professionals nowadays try to reduce the impact of self-interest amongst the most influential committee members).

The DSM-V comes out in 2011, 17 years from the last major revision of this diagnostic manual. We’ve learned a lot about mental disorders in 17 years, so you’d better believe it’s going to have a few new diagnoses and revisions for the ones that exist today to better help clinicians and consumers differentiate between them.