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

Share

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

Tradewind Recruitment: PMLD Teacher

Negotiable: Tradewind Recruitment: PMLD Teacher A specialist primary school i...

Recruitment Genius: Online Media Sales Trainee

£15000 - £30000 per annum: Recruitment Genius: Now our rapidly expanding and A...

Recruitment Genius: Public House Manager / Management Couples

£15000 - £20000 per annum: Recruitment Genius: Are you passionate about great ...

Recruitment Genius: Production Planner

£20000 - £30000 per annum: Recruitment Genius: This fast growing reinforcing s...

Day In a Page

Read Next
Michael Crabtreeof the San Francisco 49ers misses a catch during 2013's Super Bowl XLVII  

Super Bowl 2015: It's the most ridiculous sporting event of the year, but I absolutely love it

John Rentoul
 

If I were Prime Minister: I would halt the charitable status enjoyed by private schools

Rosie Millard
As in 1942, Germany must show restraint over Greece

As in 1942, Germany must show restraint over Greece

Mussolini tried to warn his ally of the danger of bringing the country to its knees. So should we, says Patrick Cockburn
Britain's widening poverty gap should be causing outrage at the start of the election campaign

The short stroll that should be our walk of shame

Courting the global elite has failed to benefit Britain, as the vast disparity in wealth on display in the capital shows
Homeless Veterans appeal: The rise of the working poor: when having a job cannot prevent poverty

Homeless Veterans appeal

The rise of the working poor: when having a job cannot prevent poverty
Prince Charles the saviour of the nation? A new book highlights concerns about how political he will be when he eventually becomes king

Prince Charles the saviour of the nation?

A new book highlights concerns about how political he will be when he eventually becomes king
How books can defeat Isis: Patrick Cockburn was able to update his agenda-setting 'The Rise of Islamic State' while under attack in Baghdad

How books can defeat Isis

Patrick Cockburn was able to update his agenda-setting 'The Rise of Islamic State' while under attack in Baghdad
Judith Hackitt: The myths of elf 'n' safety

Judith Hackitt: The myths of elf 'n' safety

She may be in charge of minimising our risks of injury, but the chair of the Health and Safety Executive still wants children to be able to hurt themselves
The open loathing between Barack Obama and Benjamin Netanyahu just got worse

The open loathing between Obama and Netanyahu just got worse

The Israeli PM's relationship with the Obama has always been chilly, but going over the President's head on Iran will do him no favours, says Rupert Cornwell
French chefs get 'le huff' as nation slips down global cuisine rankings

French chefs get 'le huff' as nation slips down global cuisine rankings

Fury at British best restaurants survey sees French magazine produce a rival list
Star choreographer Matthew Bourne gives young carers a chance to perform at Sadler's Wells

Young carers to make dance debut

What happened when superstar choreographer Matthew Bourne encouraged 27 teenage carers to think about themselves for once?
Design Council's 70th anniversary: Four of the most intriguing prototypes from Ones to Watch

Design Council's 70th anniversary

Four of the most intriguing prototypes from Ones to Watch
Dame Harriet Walter: The actress on learning what it is to age, plastic surgery, and her unease at being honoured by the establishment

Dame Harriet Walter interview

The actress on learning what it is to age, plastic surgery, and her unease at being honoured by the establishment
Art should not be a slave to the ideas driving it

Art should not be a slave to the ideas driving it

Critics of Tom Stoppard's new play seem to agree that cerebral can never trump character, says DJ Taylor
Bill Granger recipes: Our chef's winter salads will make you feel energised through February

Bill Granger's winter salads

Salads aren't just a bit on the side, says our chef - their crunch, colour and natural goodness are perfect for a midwinter pick-me-up
England vs Wales: Cool head George Ford ready to put out dragon fire

George Ford: Cool head ready to put out dragon fire

No 10’s calmness under pressure will be key for England in Cardiff
Michael Calvin: Time for Old Firm to put aside bigotry and forge new links

Michael Calvin's Last Word

Time for Old Firm to put aside bigotry and forge new links