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Thanks once again to Skin Pick Guy I have been led to yet another article about the DSM V and it’s new additions. This article is Psychiatry’s New Diagnostic Manual: “Don’t Buy It. Don’t Use It. Don’t Teach It.” and it’s hell bent on discrediting and discouraging anyone paying attention to the newest edition of the Diagnostic and Statistical Manual of Mental Health Disorders, as I’m sure you can tell from the title.
Surprisingly, I agree with some of what this lengthy article is saying. It’s right, people do abuse the DSM for disagnosing, pharmaceutical companies jump at the chance to make a buck, and people are misdiagnosed constantly. However, people are more focused on this aspect than the fact that there are actually people that need help that aren’t currently getting it because the DSM says whatever their disorder is (for example dermatillomania) doesn’t exist. While slandering the DSM, these people are essentially saying that those who need help should be disregarded completely because the system is flawed.
While I was reading this, I was thinking it’s essentially the same argument as gun control. Get rid of guns because guns are bad, while completely disregarding the fact that guns don’t kill people. People kill people. Ergo, the DSM doesn’t abuse itself, misdiagnose or anything else negative they’re saying, it’s the doctors and pharmacies and everything else that use the DSM that are doing these things. The system is what needs to be fixed, not necessarily the DSM.
I have no fantasy that the DSM is going to be perfect (or that it already is), and there is another point in the article that I do agree with. For instance, diagnoses of certain disorders are rampant, and I think unnecessary, for example, ADHD/ADD. Yes, I’m sure there are a lot of people who have and deal with this, but when every child and their brother is disagnosed with this, I think there’s a problem. But again, that’s not the fault of the DSM or the people being diagnosed, it’s the system of people who do the disagnosing. As the article says, it’s mainly the primary care doctors who are doing the diagnosing, which is perhaps the first misstep in the process. I think if doctors suspect there might be an issue they should send the person to a specialist just to be sure. But that’s where things get tricky, because then costs start to come into effect if health insurance doesn’t cover it. Even here in Canada, the land of universal health care, psychiatric care is not included in that bill. So on the one hand, we need primary care doctors to diagnose us if we can’t afford specialized treatment or appointments, but on the other, they’re probably not really trained to do so. They’re called general practitioners for a reason, and that’s because they cover the general spectrum of health issues, not the more in depth and detailed issues, such as mental health. At least that’s the way I understand it.
My problem with this article in particular is that it doesn’t even give the DSM a chance. Every question is essentially, “What is wrong with the new DSM and why?” I guess it’s fair enough that an article have an angle it’s attacking, however, I think the article would have more credibility if there were at least some positive points made. I particularly take issue with the second page of the article, “The 11 Most Harmful Changes in the DSM-5,” which blatantly attacks each of the listed changes.
Number 8 is where dermatillomania comes in: “8. DSM-5 creates a slippery slope by introducing the concept of behavioral addictions that eventually can spread to make a mental disorder of everything we like to do a lot.” I think Allen Frances (the doctor who is saying these things) is completely off base when he says this and I don’t think he even knows what behavioral addictions are judging by this statement. Behavioral addictions aren’t things “we like to do a lot.” Behavioral addictions are things we do that disrupt our lives, are a strain on our lives, prevent us from living to the fullest. I’m resisting calling him a twat for even suggesting that these are things “we like to do a lot.” Especially when I think of dermatillomania, and even trichotillomania, there are so many stories of suffering I’ve seen, so many people just begging for a magical way to stop because they can’t live like this anymore. Where does this doctor get off categorizing these as something that someone might enjoy? Addictions are not typically enjoyable and are often a hindrance in people’s lives. Does he not understand this?
He also takes a jab at binge eating disorder, suggesting by his wording that it’s not an actual disorder at all. He says it’s mere “gluttony,” as if people are just doing it for the sake of wanting to. I personally don’t have binge eating disorder, but I take issue with the fact that he would trivialize something like that as a choice. And now that I think about it, judging by his wording for behavioral addictions being something “we like to do a lot,” he probably sees them as a choice, too.
There are problems with the DSM all around, like maybe it does include too much, maybe it does need some refining, but the bigger problem is in how people use it, and the fact that to get treated for any sort of mental disorder it pretty much needs a listing in the pages of this book. The book is not at fault, it’s the system and the people who use it. I don’t understand why people are denouncing a book instead of taking the time to think, “how can I use this properly and to help people?” I don’t understand why they aren’t looking at the system and going, “aha! That’s the problem right there!”
The more people discredit the DSM, the more there will be people that will go without help. If you’re not going to fix the system so that we don’t need a book to tell us what’s wrong with us, then don’t punish us by saying that our disorders are illegitimate. Having a book with a list of mental health issues/disorders is one thing. To make it a requirement for diagnosis and treatment is entirely another. And that’s right there is a big problem.