Friday, February 3, 2012 |
The Diagnostic and Statistical Manual of Mental Disorders -- better known as the DSM -- is the American Psychiatric Association's bible for mental health clinicians. A new edition of the big book (and with 886 pages listing the 374 known mental disorders, it really is a BIG book), the DSM-5, is due out next spring. That means that right now, a committee of psychiatrists is debating how psychiatric disorders will be defined and what gets tossed out or added to the manual.
It's a contentious debate, and the arguments are already breaking out from beyond the board room walls. Recently, there was outcry over the proposed tightening of the definition of autism, and a new debate has emerged over the definition of grief and depression in the DSM-5.
Jon Ronson is the author of The Psychopath Test, a book that deals with some of the thorny issues of psychiatric diagnosis, including the origins of the DSM. He spoke with Day Six about where the DSM comes from, and where it's going.
"What's funny about the DSM is that the DSM 1 was a tiny little pamphlet, and DSM-2 was a bit bigger -- they just kept coming up with new mental disorders," said Ronson. "And by the time they got to 4, it was vast -- bigger than the New Testament, the Old Testament and the Talmud all put together."
Needless to say, flipping through this list of all the things that can be wrong with one's personality can be a harrowing experience for anyone with the slightest tendency towards hypochondria. "At first you leaf through it and you spot all the obvious ones like schizophrenia and OCD...and then you start to think, 'well, I wonder if I've got any mental disorders," said Ronson. "And you leaf through it with increasing panic because you realize you've got loads. I've diagnosed myself with 12 mental disorders."
The oddest of Ronson's self-diagnoses is something called "Nightmare Disorder" which is categorized by recurrent dreams of being pursued or being declared a failure. "Of course all my dreams involve people chasing me down the street yelling 'you're a failure,'" deadpanned Ronson. "So that was a no-brainer."
A man named Robert Spitzer who hated Freudian psychotherapy became the editor of DSM-3 in the early 1970s (the edition was finally published in 1980).
"He got a whole bunch of like-minded people who believed in something more scientific than sleuthing around the unconscious," said Ronson. "They believed in checklists." Over the course of eight years, these people would come up with disorders such as bulimia and ADHD, and quantify their symptoms in a checklist. (One that was rejected was "atypical child syndrome"--- the person who proposed it was unable to come with a standardized checklist, because "the children are very atypical.")
"And that's how the DSM went from tiny to huge," Ronson said. "Pretty much every disorder you may have been diagnosed with came from those sessions." Though Ronson disagrees with many of the entries in the DSM, he isn't a polemicist about it; he agrees that with many disorders -- OCD, for example -- a diagnosis is a very helpful thing. But for others, such as childhood bipolar disorder (which is only classified as a disorder in North America; it doesn't technically exist in Europe), diagnosis can be dangerous, especially when it involves four or five year old children being put on anti-psychotic medication to curtail their temper tantrums.
The Psychopath Test
by Jon Ronson
Buy this book at:
From the publisher:
In this madcap journey, a bestselling journalist investigates psychopaths and the industry of doctors, scientists, and everyone else who studies them. The Psychopath Test is a fascinating journey through the minds of madness. Jon Ronson''s exploration of a potential hoax being played on the world''s top neurologists takes him, unexpectedly, into the heart of the madness industry. An influential psychologist who is convinced that many important CEOs and politicians are, in fact, psychopaths ...
Read more at Penguin Canada