Diagnosing the D.S.M.

Over the weekend, a prominent psychologist argued in the New York Times that the Diagnostic and Statistical Manual, alterations to which have sparked numerous bitter and divisive controversies over the past few decades, has outlived its usefulness and should no longer be taken as the definitive authority in its field. Arguing that it’s past time to “break up the psychiatric monopoly,” Allen Frances writes:

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. . . .

[While the third edition] caught on with the general public and became a runaway best seller, with more than a million copies sold, many more than were needed for professional use. Psychiatric diagnosis crossed over from the consulting room to the cocktail party. People who previously chatted about the meaning of their latest dreams began to ponder where they best fit among D.S.M.’s intriguing categories.

The fourth edition of the manual, released in 1994, tried to contain the diagnostic inflation that followed earlier editions. It succeeded on the adult side, but failed to anticipate or control the faddish over-diagnosis of  autism , attention deficit disorders and  bipolar disorder  in children that has since occurred.

Indeed, the D.S.M. is the victim of its own success and is accorded the authority of a bible in areas well beyond its competence.

Worries about psychology’s permeation into the culture in are nothing new (Philip Reiff’s Triumph of the Therapeutic was published in 1966), but the way this particular medical manual has become a touchstone over the last couple of decades—a kind of holy writ whose influence has burst out of the profession it was intended to serve and crept into politics, family life, and moral argument—does seem to represent a further development of that infiltration. Which is why it’s refreshing to see such a highly-qualified, serious observer of psychology air these concerns—it makes it far more difficult to dismiss the substance of these criticisms as marginal or reactionary, the usual hyperventilations of an “anti-science” crowd.

Read Frances’ argument in full here .