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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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