First DSM (1952) had 106 disorders, the number has almost tripled. Are we getting sicker, or is something else at play?
The DSM (Diagnostic and Statistical Manual of Mental Disorders) is widely regarded as the bible of psychiatric diagnoses. Its authority extends not only to this country’s schools, prisons, court system, and health-insurance industry, where it is daily invoked, chapter and verse, but also around the world, where it is highly influential in defining mental illness. It’s currently in its fourth edition, and a fifth is due out in 2013. With each edition the number of diagnoses greatly increases, and the thresholds for meeting them are routinely lowered. The number of people who can be defined as mentally ill has grown to the point where Darrel Regier of the American Psychiatric Association says that mental disorders affect some 48 million Americans in their lifetimes. That’s one in six people. And he’s basing that judgment entirely on DSM criteria and language.
Behaviors once understood as reactions to one’s environment and upbringing are increasingly seen as innate conditions of brain chemistry, resulting from problematic levels of neurotransmitters, especially serotonin. Lane suggests that because of the open-ended language in the DSM and the wide range of behaviors it pathologizes, anyone who is shy, as he was as a teenager, now risks being diagnosed as mentally ill. The new disorders were “obviously music to the ears of drug companies,” he says, “insofar as they massively increased the market for their products, which the media greeted with incredible enthusiasm.”