Diagnostic categories are negotiated

From the outside, diagnostic categories appear so real while actually most of the time they are cultural constructs. That is groups of professionals get together and decide what is a disease and what is not. This is not as scientifically based as we imagine.

Studying the history of the psychiatric diagnostic categories listed in the various editions of the DSM (Diagnostic and Statistical Manual) provide a convenient way to begin to understand this phenomenon.

The DSM is extremely important for psychiatrists because insurance companies use it to decide what diseases are “real” and therefore eligible for insurance. These days, it is much easier to get reimbursed if there are pharmaceuticals which can be prescribed.(Is the tail wagging the dog?)

Crudely speaking, mental health professionals want to get paid for their services and therefore work hard to label their patients with diseases that are reimbursable.

Right now, work is being done on the coming 5th edition of the DSM and the battles over what’s what are energetic and occasionally visible to the public.

Diagnostic categories are important. For many people, it is easier to stop taking their pills than it is to stop thinking of themselves as their diagnosis.(i.e. “I’m bipolar.” I’m a depressive.” etc.)

This is particularly true when the patient is a child or an adolescent. It is important not to be too quick in labeling a person with a psychiatric category.

Here is a short introduction to some of the pertinent issues involved in deciding the categories.

from a Project Syndicate article by Jerome C. Wakefield

NEW YORK – The American Psychiatric Association’s recent proposed changes to its official diagnostic manual – theDiagnostic and Statistical Manual of Mental Disorders (“DSM”), often called the “bible of psychiatry” – may discredit psychiatric diagnosis more than improve it. The DSM specifies the symptoms by which every mental disorder is diagnosed, in effect defining what is psychologically normal and abnormal in the United States – and, increasingly, for much of the rest of the world as well.

Revising the DSM’s diagnostic criteria for the upcoming fifth edition (“DSM-5”) is a heavy responsibility. Draw the line between normality and disorder too broadly, and individuals may suffer incorrect diagnoses and undergo needless and potentially harmful treatment. Indeed, the DSM’s history reveals many such errors of over-inclusiveness.

But if the line is drawn too narrowly, individuals may not get needed help. Although psychiatrists tend to worry more about identifying potential patients in need of help and less about eliminating normal eccentricity and distress from diagnosis, it is crucial in any society that respects human variation and encourages individual moral responsibility to distinguish normal suffering and eccentricity from mental disorder.

These are delicate issues of conceptual analysis. Yet the psychiatrists who formulated the DSM-5’s proposed changes are not trained in conceptual analysis, and, though amply forewarned, they have addressed the normal-versus-disordered issue in an unsystematic, ad hoc manner. The result is a form of conceptual malpractice: intellectual negligence resulting in the formulation of invalid diagnostic criteria that will misdiagnose normal individuals as disordered….

..All the above categories encompass some genuine disorders. The problem is that the criteria are drawn so broadly that they pathologize mostly the non-disordered. Normal individuals often need and deserve help, but the decision as to the kind of help they get should not be biased by incorrect labeling of their conditions as mental disorders that suggest something is internally wrong with them…

much more via Psychiatry’s Conceptual Malpractice on Project Syndicate

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