The DSM-5 - Stop Ignoring Mental Illness

My brand new article, hot off the press at The Periodical - a brilliant news/current affairs/columns/science-filled site owned, designed and filled by young people from across the country. 

In the public eye mental illness is dramatized, romanticised and sometimes even ostracised. All too often leaving people shunned from society, disregarded and disrespected, mental illness is just one more of the many reasons our press must be called into question. The problem, in this case however, runs much deeper than our tabloids and online bulletins.  To call it a fundamental misunderstanding would be incorrect, because even in the professional sphere, where the greatest understanding is held, there is constant debate and controversy over the status, description and diagnosis of mental disorders.  At a time when the BBC has recently reported a rise in depression and anxiety cases in young people (even extending to the under fives) and the British Psychological Society (BPS) has reported a significant jump in mental illness-related absence from work, found by the manufacturers’ body EEF, it is certainly true that mental illness demands and deserves a key focus in the public sphere. However, what recent months are seeing is a turn away from the real illnesses and a rise in debate, bureaucracy and factionalism.

The reason? An important development is happening in the world of psychology and psychiatry. The Diagnostic and Statistical Manual of Mental Disorders (DSM) is undergoing a total overhaul and an extensive re-writing, editing and peer-review process, with dramatic outcomes for new and long-established disorders alike. For those in the mental health profession, lecturers or young psychology enthusiasts like me, this is a hugely exciting and important move. It is a chance to redefine the disorders collecting dust and criticism, it is a chance to prevent people with previously undefined disorders falling through the safety net and it is a chance to raise the profile of the profession that directly deals with our well-being and psychological health. I’m painfully aware, however, that a large proportion of young people, or in fact people in general, have not even heard of the DSM, let alone stopped to consider the effects of replacing  ‘autistic disorder’, ‘Asperger’s disorder’ and ‘Pervasive developmental disorder not otherwise specified’ with the arguably more succinct and accurate ‘autistic spectrum disorder’.

Yet this, along with several other issues, is at the heart of real controversy. The frightening truth is that this one book, published by one association in America, is the difference between services or no services for people across the globe. Parents of children with Asperger’s, for example, are worried that this change in definition will mean their high-functioning and high-achieving child may miss out on the help and support they require. The editing of the DSM is designed to make psychiatrists’ jobs easier, and make diagnosis more accurate and helpful – yet people are panicking over the effects. While it is easy to say that health professionals have everyone’s best intentions at heart, when you consider the effects of the economic greed machine that is drugs companies and perhaps rather less cynically note the lack of concrete visual evidence in so many mental disorders, you begin to think that parents have every right, and indeed every need, to worry. There are so many fine, or even dotted, lines so take into account – work by Baron-Cohen has argued the nature of Asperger’s as an example of the ‘extreme male brain’; so what is to stop every somewhat obsessive and shy man from being included in the diagnosis?

Once the drafting phase began, criticism came thick and fast, attacking all areas of the edits. According to ‘Psychology Today’, disorders (like binge eating, minor cognitive disorder and the very controversial ‘pre-psychotic risk syndrome’) were too common, leading to unnecessary service use and grief for ‘neurotypical’ patients.  According to the BPS, some edits (including to ADHD, ‘delusional disorder’ and schizophrenia) encouraged over-medicalisation of disorders where other forms of treatment could be effective. Time Magazine noted the lack of distinction between clinical depression and the standard grieving progress after bereavement. This issue, like the issue with autism, has been discussed at great length in the press, public and private homes. Extended grieving after bereavement is normal and not usually treatable as such, yet bereavement can also lead to longer-term mental health issues that need proper diagnosis and treatment.

Following the torrents of anger and confusion – both in the professional and public domain, the American Psychiatric Association has amended some of the areas under fire. Footnotes have been added to distinguish between bereavement related depression and more conventional and unexplained depression. Some debated disorders have even been removed from the upcoming publication. Perhaps most importantly, the DSM-5 has been reopened for public addition and comment. It is monumental that such a document, and one traditionally relatively furtive and enclosed, has reacted to public opinion, has listened to professional criticism and is changing accordingly.

But the issues are anything but neatly ironed out. The worry remains for parents of affected children, the state of limbo remains for patients on the debated and reforming edge of diagnosis and the anger will remain for as long as the DSM appears to be economically driven, modernising for the sake of it, or simply ‘out of touch’. The fields of psychiatry and psychology depend so entirely and fairly exclusively on the DSM, and will continue to do so in May 2013 when the DSM-5 is finally published. While these fields are long entangled in controversy, confusion and frustration and are so often portrayed to be failing their patients, they are services that have and always will be incredibly important. They may not fix visible wounds, they may not always categorise and define individuals as precisely as hoped and they certainly fail to please all the parents, patients and public fora they encounter – but they aim and so often succeed in helping those members of our community this ‘man-up-and-deal-with-it’ society entirely neglects. Amongst the exciting wait for the DSM, the factional infighting and the furious debate, what this writer is really trying to portray is this: for just a few short months psychiatry and psychology will get nothing but bad press, but perhaps the underlying issue is that without such monumental changes at the centre of mental health, mental illness would get no real press at all.

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