Despite what the DSM implies, medical intervention is not always the answer to mental health issues

You don't need to be a mental health professional to take an interest in the recently published fifth edition of the Diagnostic and Statistical Manual of Mental Disorders


The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has just been published and the contents of this book should really be of interest to you. The DSM is not simply a medical handbook that provides a list of conditions worthy of the diagnosis of mental illness. It is also a secular bible that instructs people how to make sense of their predicament through the language of medicine.

With every edition of the DSM, the number of conditions diagnosed as a problem suitable for psychiatric intervention expands. You, dear reader, may be suffering from a mental illness that you never knew existed. So if like me you really get angry now and then, the DSM suggests that you may be suffering from “disruptive mood dysregulation disorder”. Or if you have the occasional senior moment, you may well be afflicted with the new diagnosis of “mild neurocognitive disorder”. And if you really feel anxious and scared about experiencing pain and discomfort, you may have “somatic symptom disorder”.

The eccentric loner, the shy stranger lacking in social skills, the naughty child, anyone who eats too much or the sexually confused teenager have all become candidates for the psychiatrist’s couch. What’s important about the DSM is that it provides a language and narrative through which the problems of existence become medicalised. And in a world where a medical diagnosis represents a claim for resources, what the DSM says really matters. The verdict of the DSM not only affects insurance and drug companies interested in their bottom line but also anxious parents who rely on a diagnosis to gain special help for their child.

Not surprisingly, the latest edition of the DSM has become a subject of controversy. Different groups of medics and psychiatrists have questioned the scientific reliability of some of the new diagnostic categories. Some have queried the dropping of the category of Asperger’s syndrome and the decision to include it under a general autism diagnosis. Others argue that the psychiatric lobby has become a captive of the pharmaceutical industry. But what is not at issue is the ethos of medicalisation promoted through this influential manual.

The term medicalisation refers to the cultural process through which a range of human experience is reinterpreted through the language of medicine. In recent decades, many everyday experiences have become redefined as issues of health that require medical intervention. Through reinterpreting existential problems such as loneliness, shyness, fear, anxiety, loss of control or grief as medical ones, the meaning people attach to them fundamentally alters.

Medical problems require treatment and rely on professional intervention to cure the patient’s illness. But why should grief or shyness or even anger be treated as a disease? And why should professionals possess a monopoly on how to interpret the pain and disappointment that people experience at different stages of their lives? The real threat posed by the expansion of mental health diagnosis is that it takes away from people the confidence that they need to make sense and give meaning to their personal experience.

The problem is not that professional advice is always misguided, but that it short-circuits the process through which people can learn how to deal with problems through their own experience. Intuition and insight gained from experience are continually compromised by professional knowledge. This has the unintentional consequence of estranging people from their own feelings and instincts since such reactions require the affirmation of the expert. In such circumstances, people’s capacity to handle relationships and to have confidence in their relationships diminishes further. In turn, this creates new opportunities for professional intervention in everyday life.

The manner in which emotional problems have become diagnosed as a form of disorder raises questions about the ability of the individual to deal with disappointment, misfortune, adversity or even the challenge of everyday life. And, sadly, when people are continually invited to make sense of their troubles through the medium of therapeutics, it severely undermines their resilience.

Once the diagnosis of illness is systematically offered as an interpretative guide for making sense of distress, people are far more likely to perceive themselves as ill. That is one reason why in Western society the number of people diagnosed as suffering from mental illness has risen exponentially. The explanation for this trend lies not in the fields of epidemiology, but in the realm of culture that invites people to classify themselves as infirm.

Recently, the British Psychological Society’s division of clinical psychology has attacked the psychiatric profession for offering a biomedical model for understanding mental distress. But its criticism was not directed at the ethos of medicalisation as such, but only at the tendency to associate mental illness with biological causes. What it offered was an alternative model of medicalisation – one where mental illness was represented as the outcome of social and psychological cause. It seems that medicalisation has become so deeply entrenched that even critics of the DSM accept its premise.

The problems of life can be painful. But this experience of existential agony must not be rebranded as an illness. Medicalisation empties experience of its creative content and assigns human beings the status of permanent patients. The promiscuous expansion of diagnosis also trivialises mental illness. Learning to distinguish between normal suffering and illness is a mark of a mature and confident culture.

Frank Furedi is a sociologist whose books include ‘Therapy Culture’

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Recruitment Genius: Telesales & Customer Service Executive - Call Centre Jobs

£7 - £9 per hour: Recruitment Genius: Are you outgoing? Do you want to work in...

Ashdown Group: Finance Manager - Covent Garden, central London - £45k - £55k

£45000 - £55000 per annum + 30 days holiday: Ashdown Group: Finance Manager - ...

Ashdown Group: Systems Administrator - Lancashire - £30,000

£28000 - £30000 per annum: Ashdown Group: 3rd Line Support Engineer / Network ...

Recruitment Genius: Graduate Web Developer

£26000 - £33000 per annum: Recruitment Genius: A Web Developer is required to ...

Day In a Page

Read Next
David Cameron met with Ukrainian President Petro Poroshenko prior to the start of the European Council Summit in Brussels last month  

David Cameron talks big but is waving a small stick at the Russian bear

Kim Sengupta

Isis in Iraq: Even if Iraqi troops take back Saddam’s city of Tikrit they will face bombs and booby traps

Patrick Cockburn
The difference between America and Israel? There isn’t one

The difference between America and Israel? There isn’t one

Netanyahu knows he can get away with anything in America, says Robert Fisk
Families clubbing together to build their own affordable accommodation

Do It Yourself approach to securing a new house

Community land trusts marking a new trend for taking the initiative away from developers
Head of WWF UK: We didn’t send Cameron to the Arctic to see green ideas freeze

David Nussbaum: We didn’t send Cameron to the Arctic to see green ideas freeze

The head of WWF UK remains sanguine despite the Government’s failure to live up to its pledges on the environment
Author Kazuo Ishiguro on being inspired by shoot-outs and samurai

Author Kazuo Ishiguro on being inspired by shoot-outs and samurai

Set in a mythologised 5th-century Britain, ‘The Buried Giant’ is a strange beast
With money, corruption and drugs, this monk fears Buddhism in Thailand is a ‘poisoned fruit’

Money, corruption and drugs

The monk who fears Buddhism in Thailand is a ‘poisoned fruit’
America's first slavery museum established at Django Unchained plantation - 150 years after slavery outlawed

150 years after it was outlawed...

... America's first slavery museum is established in Louisiana
Kelly Clarkson: How I snubbed Simon Cowell and become a Grammy-winning superstar

Kelly Clarkson: How I snubbed Simon Cowell and become a Grammy-winning superstar

The first 'American Idol' winner on how she manages to remain her own woman – Jane Austen fascination and all
Tony Oursler on exploring our uneasy relationship with technology with his new show

You won't believe your eyes

Tony Oursler's new show explores our uneasy relationship with technology. He's one of a growing number of artists with that preoccupation
Ian Herbert: Peter Moores must go. He should never have been brought back to fail again

Moores must go. He should never have been brought back to fail again

The England coach leaves players to find solutions - which makes you wonder where he adds value, says Ian Herbert
War with Isis: Fears that the looming battle for Mosul will unleash 'a million refugees'

The battle for Mosul will unleash 'a million refugees'

Aid agencies prepare for vast exodus following planned Iraqi offensive against the Isis-held city, reports Patrick Cockburn
Yvette Cooper: We can't lose the election. There's too much on the line

Yvette Cooper: We can't lose the election. There's too much on the line

The shadow Home Secretary on fighting radical Islam, protecting children, and why anyone in Labour who's thinking beyond May must 'sort themselves out'
A bad week for the Greens: Leader Natalie Bennett's 'car crash' radio interview is followed by Brighton council's failure to set a budget due to infighting

It's not easy being Green

After a bad week in which its leader had a public meltdown and its only city council couldn't agree on a budget vote, what next for the alternative party? It's over to Caroline Lucas to find out
Gorillas nearly missed: BBC producers didn't want to broadcast Sir David Attenborough's famed Rwandan encounter

Gorillas nearly missed

BBC producers didn't want to broadcast Sir David Attenborough's famed Rwandan encounter
Downton Abbey effect sees impoverished Italian nobles inspired to open their doors to paying guests for up to €650 a night

The Downton Abbey effect

Impoverished Italian nobles are opening their doors to paying guests, inspired by the TV drama
China's wild panda numbers have increased by 17% since 2003, new census reveals

China's wild panda numbers on the up

New census reveals 17% since 2003