The American Psychiatric Association (from which I resigned in protest, some time ago) is at it again—making up, then retracting, new diagnoses that their committees generate and debate. It's as if those committees have some sort of microscope trained on humanity, identifying new pathologies and yelling, “Voila! We have found another illness! Behold the mind malady on the slide!”
In this case, while preparing to publish its big seller (and huge profit center), the Diagnostic and Statistical Manual of Mental Disorders V (DSM-V)—organized psychiatry’s compendium of known psychiatric illnesses—the powers that be at the APA have decided to remove from its latest revision of the manual a few diagnoses they thought they would include: “attenuated psychosis syndrome” and “mixed anxiety depressive disorder.” They are, however, sticking with their notion of jettisoning from the DSM-V, the diagnosis of Asperger’s Syndrome, while picking up one they call, “Autism Spectrum Disorder.”
This would be really funny, if it weren’t really dangerous. The DSM-V will be used by hundreds of thousands of clinicians who may think that they are understanding their patients better, or treating them more expertly, by labeling them with one of 300 or so disorders listed in it, then matching medications to those supposedly genuine labels. But those labels aren’t driven just by science, but by political, economic and commercial forces within the American Psychiatric Association that may have nothing to do with the wellbeing of patients – or with reality.
The labels in the DSM-V (like the Diagnostic and Statistical Manuals that came before it) have really become little more than the roadmap by which psychiatrists chase both insurance reimbursement and applause from special interest groups who lobby—sometimes very effectively—for one diagnosis to be included, or another to be removed.
See, without a numbered diagnosis—such as number 312.30 Impulse-Control Disorder Not Otherwise Specified or number 307.47 Nightmare Disorder (formerly Dream Anxiety Disorder)—insurance companies won’t write a check to social workers, psychologists or psychiatrists who help people who have terrible outbursts or can’t sleep. Without a numbered diagnosis, pharmaceutical companies can’t get an FDA indication to use a particular medicine for that diagnosis. And without a numbered diagnosis, psychiatric wards can’t get paid to treat patients who hear voices or see visions or are dependent on heroin.
Never mind that splicing and dicing the range of human experience into a recipe book of contrived illnesses does damage to the miraculous healing power of empathy, which just happens to be psychiatry’s birthright. Never mind that creating a constantly-evolving dictionary of disorders wrenches the wonderful tools of psychotherapy and psychiatric medications into a realm of fiction that can paralyze them—like, for instance, the time that the American Psychiatric Association removed Ego-Dystonic Homosexuality from the DSM, essentially making the case that people who have sexual impulses they themselves dislike and wish to resist need no help at all and are pretty much normal. Similarly, now, for those with Asperger’s Disorder, which no longer exists as a distinct entity because someone on some committee convinced other people on that committee that it just doesn’t.
So, there. Take two of those, and call me in the morning.
Mind you, this is the same organization purporting to represent American psychiatrists while refusing to say just what percentage of those psychiatrists belong to it. It is the same organization that has presided over the near decimation of insight-oriented psychotherapy—still far-and-away the best technique, in capable hands, that we have to truly heal those suffering with mental disorders.
We in America face an epidemic of fiction—manipulations of the truth on a scale never before known, fueled by technology and media. This epidemic threatens to rob us of ourselves—what we truly think and truly feel and truly know as fact. And this epidemic has clearly infected the American Psychiatric Association, which puts them on the wrong side of Truth, and puts patients at needless risk.
Keith Ablow, MD is a psychiatrist, and was host of the nationally-syndicated "Dr. Keith Ablow Show." He is a former member of the Fox News Medical A Team.