The Great DSM Hoax


I have been reading Marilyn Wedge’s excellent Pills Are Not for Preschoolers and it moved me to write again about the extent to which the DSM, the “diagnostic manual” used by the psychotherapeutic professional class, is an utter hoax.

You may be familiar with complaints surrounding the American Psychiatric Association’s DSM as those complaints have mounted in recent months in connection with the imminent appearance of the next version of the DSM, the DSM-V, which is scheduled to appear in 2013. In that volume a slew of new “mental disorders,” created out of whole cloth for profit, will appear. Many people, including thousands of mental health professionals, have pushed back. But too few are willing to call the whole thing the hoax it is.

The DSM is a disease-mongering naming game where collections of disparate painful thoughts and feelings and unwanted or distressing behaviors are given profit-seeking labels. That is all the DSM does. It tells a story about life, that behaviors like restlessness and feelings like sadness are medical problems, without ever announcing its premises or its motives. It doesn’t just name or label: it imputes. By calling sadness “depression” or restlessness “attention deficit disorder” it secretly imputes biological causes for which there is no evidence. They want us to believe that biological abnormality is at play, so that they can prescribe drugs, without having to frankly say that there are biological abnormalities at play, which might require that they prove their assertions.  

It is one thing to say that when you see the numeral 2 you are to call it “two.” It is a rather similar thing to say that when you see a bird with feathers of this color and a beak of this sort you are to call it an oriole. That is simple naming for the sake of communication and convenience. But when you assert that when you see an oak, a rose, or a giraffe you are to call them “God’s handiwork,” that is not naming. That is imputing. That is telling a loaded story under the guise of naming. The DSM, which has sometimes been criticized as a naturalist’s guide to mental disorders, is far worse than that. It doesn’t just name: it imputes causes it is completely unjustified in ascribing.

Calling the sadness you feel because your parents are fighting or calling your entirely understandable boredom at school a “mental disorder” is not just naming. The causes of your “disorder” are being ascribed without anyone saying anything overt. The DSM tells a secret, silent, never-explained story as it gets from “a restless child who gets up six times at school but never gets up when he visits his grandmother who lets him play video games” to “attention deficit disorder.” How did it get there? Just by using language in a way that too many people find plausible and seductive.

You will agree that a label like “attention deficit disorder” seems to be positing some biological malfunctioning? Yet the American Psychiatric Association’s own current definition of a mental disorder contains not a word about biology, defining a mental disorder as a “psychological or behavioral syndrome.” It is rather amazing that in the definition of a mental disorder the psychotherapeutic professional class admits that they do not believe for an instant that there are biological irregularities going on, even though their labels are imputing precisely those causes.

They probably feel free to admit it there, in the definition of a “mental disorder,” because they know that no one, not even members of their professional class, will ever actually look at the definition. So they are safe in admitting a bit of the truth there. Then, when questioned in Heaven, they will be able to say, “Look we never said that this has anything to do with biology. We can’t help it that people thought we did and that they thought that because we were prescribing medication that there was something biologically wrong with them. That’s their fault, not ours. Look, we clearly defined a ‘mental disorder’ as a ‘psychological or behavioral syndrome.’ We never said that biology was involved. We have no clue where they got that idea.”

For indeed the current definition of “mental disorder” says nothing about biology. Ah, but perhaps because of the scrutiny being put on the DSM-V creators, who maybe now fear that someone will actually look at their definition, they have proposed a massive change to the definition of “mental disorder” to include biology. They intend it now to read: “A Mental Disorder is a health condition characterized by significant dysfunction in an individual’s cognitions, emotions, or behaviors that reflects a disturbance in the psychological, biological, or developmental processes underlying mental functioning.”

One might sensibly ask: what, did you forget to include “biology” in the current definition, in the one that every mental health provider supposedly is using right this minute? Did “biology” escape your mind or your notice? Did you have a “blind-to-biology disorder”? And are you now saying that the current definition, which makes no mention of biology, is untrue? Are you saying that it is a mistake? If it is a mistake, is it not dangerous and perhaps even actionable to let it just stand? Please tell us which one is right!  

Just ask yourself: how can you drop “biology” into the definition of a “mental disorder” as if you had added a comma or a semi-colon? Either the current definition is incorrect or the prospective definition is incorrect. They can’t both be correct. They can indeed both be incorrect, and they are, but they can’t both be correct. So which is the correct one, DSM creators, and what is your justification for dubbing the one correct and the other incorrect? Have you just “changed your mind,” as your predecessors did when they changed their mind about homosexuality being a mental disorder?    

Is the proposed definition of a “mental disorder” a truer definition than the previous one? No, it is the same hoax: and in fact the creators of the DSM blithely announce that they are unconcerned about whether or not their definition of a “mental disorder” is true. They explain that “The diagnosis of a mental disorder should have clinical utility,” not that it should be true. There you go. Since they do not mean by clinical utility that a diagnosis be either valid or reliable, they must mean that it be profitable.

In fact, tellingly enough, as a prospective client you do not to meet their own proposed criteria in order to receive treatment. They explain: “Clinicians may thus encounter individuals who do not meet full criteria for a mental disorder, but who demonstrate a clear need for treatment or care. The fact that some individuals do not show all symptoms indicative of a diagnosis in these individuals should not be used to justify limiting their access to appropriate care.”

Wow! Isn’t that a clever sentence? Orwell would have loved it. This translates as: “We say that we are using this manual to diagnose you but since our labeling scheme is a hoax and our criteria are trumped up to begin with, it certainly doesn’t matter to us whether you meet them or not—we are happy to medicate you simply by virtue of you having walked through the door.”

There can be no real change in this procedure until politicians intervene; and they will not intervene because of the power of Big Pharma. Perhaps when some senator notices that her six-year-old son, who is on an antidepressant, an anticonvulsant, and an antipsychotic, has suffered a psychotic break that will cost him his whole adult life, she will be moved to say, “I don’t care how much Big Pharma is paying me, I’m sick of this lie.” Perhaps then some questions will get asked by people with the clout to demand real answers. Until then the hoax will continue.   

**

Eric Maisel, Ph.D., is a psychotherapist, bestselling author of 40 books, and widely regarded as America’s foremost creativity coach. His latest book is Rethinking Depression: How to Shed Mental Health Labels and Create Personal Meaning (New World Library, February, 2012) and is available here. Dr. Maisel is the founder of natural psychology, the new psychology of meaning. Please visit Dr. Maisel at http://www.ericmaisel.com or contact him at ericmaisel@hotmail.com. You can learn more about natural psychology at http://www.infinitemeaningclass.com.

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