‘Mind Field,’ a short review published in the Financial Times on May 24, 2013, seems to me the most succinct, insightful review of Diagnostic Statistical Manual-5 to date. In well under 1000 words, Talitha Stevenson points out the limitations of DSM. My summary of her points runs as follows:
1. That the DSM seeks to make a firm, clean distinction between ‘normal’ and ‘disordered’ behavior (a criterial conundrum);
2. That it multiplies unduly the number of categories to the point of absurdity (an epistemic conundrum);
3. That it has successfully transformed a set of tools or constructs–themselves dubious–into pseudo-scientific claims (a conundrum about the scope of an object domain);
4. That, over time, the theory of chemical imbalances has come to seem self-evidently true; (an evidentiary conundrum)
5. That there is insufficient evidence to demonstrate that drug therapy is anymore effective than placebos in the treatment of depression (which begs the question about the hegemony of drug therapy);
6. That the pharmaceutical industry has gained too much power over our mental lives (a question of power);
7. And that it fails to grasp the fact that human beings, in virtue of being the complex creatures we are, would feel grief over the loss of a beloved (a conundrum concerning the excised ‘bereavement exclusion’).
The most curious aspect of the status quo in psychiatry, though, is how a scientific-looking manual put out by a small organisation with no public accountability has come to be viewed with such reverence. Not for nothing is the DSM known as “the psychiatric bible”. Perhaps its bullet-pointed diagnoses do satisfy a religious need, the old existential ache for reassurance that “even the hairs of your head are all counted” and there’s no reason to be afraid.