DSM-5 Published to a Chorus of Criticism

The long-anticipated revision to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has been published.

Although the exact wording of many sections of the book had not been widely known pre-publication, the essential features of its changes have been known for some time now. And the drumbeat of criticism has been constant. In a view from across the pond, where the DSM is not officially used, this article from the Guardian summarized many of the critiques that have already appeared elsewhere.

The DSM has been called many names, and in some circles is referred to jokingly as the “Drug-Selling Manual.” As the Guardian points out,

Though not used in the UK, … the US manual has global influence. It defines groups of patients, and introduces new names for disorders. Those names can spread, and become the norm elsewhere. More importantly, the categories redefine the populations that are targeted by drugs companies.

With characteristic British understatement, the article goes on

Criticisms have come from almost every corner.

And lists quite a few, among them these:

Nick Craddock, professor of psychiatry at Cardiff University, and director of the National Centre for Mental Health in Wales, said … DSM-5 was flawed because definitions of disorders were sometimes changed on the basis of too little fresh scientific evidence.


Last month, Thomas Insel, director of the National Institute of Mental Health, declared that the organisation would not use DSM-5 definitions to set its research priorities. Writing about DSM-5 on his blog, he said: “The weakness is its lack of validity. Unlike our definitions of ischaemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure.” Instead, he said the NIHM would lay the foundations for a new classification system, based on brain imaging, genetics, cognitive science and other research.

“We need to begin collecting the genetic, imaging, physiologic, and cognitive data to see how all the data – not just the symptoms – cluster and how these clusters relate to treatment response,” he said.

My personal criticism, as an autistic person, is more fundamental. I do not believe that autism belongs in a “Manual of Mental Disorders” because I don’t view it as a “disorder” but as a different order; a brain structure that creates a different way of being in the world.

So far as I know, there has not yet been discovered any drug that can “treat” the underlying “symptoms” of autism. For good reason, I think. One might just as well “treat” left-handedness with a drug.

All of this is not to minimize the difficulties of being autistic. Believe me, I know, from personal experience, how debilitating a disability autism can be. But it is not a mental health condition, and it does not deserve to be pathologized by being placed in the DSM.



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