The New York Times on the DSM V

The New York Times today carried a story about the machinations and politics behind the DSM V, the diagnostic and statistical manual used by therapists and medical doctors to assign diagnoses to patients seeking treatment.

What strikes us is that the DSM is one of the most obsessive works to come out in the long and obsessive history of psychiatry and psychotherapy. It catalogues in scrupulous detail the symptoms needed to achieve a diagnosis of a particular disease entity (that's a term I use to indicate that in the case of affective disorders symptoms can be organized in different ways and produce different diagnoses). The point is that many of the illnesses listed are made by committees that have to determine which symptoms, how many, and how frequently they occur can tip the balance and produce the diagnosis. Obsessive physicians and researchers are obsessively studying people who may themselves be labeled as obsessives.

Interestingly, the DSM IV TR says quite specifically that the purpose of the work is to "enhance agreement" among practitioners. This agreement, like other forms of consent, is manufactured, as we see with the NY Times report. Various groups are lobbying for and against the inclusion of new illnesses. So disease entities are more properly regarded as constructs created by obsessive cataloguers and researcher. This doesn't ‘mean that people can't suffer from such "diseases," but the etiology and the dispersal of these categories needs more scrupulous (I guess more obsessive) study themselves.

And if we look at OCD, we'll see a meteoric rise in the number of cases from the 1960's to now. Back in the day, OCD was an extremely rare disease, now the World Health Organization ranks it number four of all mental disorders. How did that rise come about? As with other disorders like bipolar depression and ADD, and now perhaps "shopping addiction," a complex mix of the social, cultural and economic have come into play and a mixed group of players like the writers of the DSM, the drug companies, and whatever zeitgeists are floating around-all have produced a social reality.