Just when you’ve finally come to the conclusion that you are not insane after all (despite what family and friends might say), medical professionals around the world would urge you to think again.

BERND FISCHER

Just when you’ve finally come to the conclusion that you are not insane after all (despite what family and friends might say), medical professionals around the world would urge you to think again. If a number of psychologists get their way, the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will change the face of modern psychology as we know it. Perdeby investigates the most controversial amendments that may feature in the new edition of this medical Bible.

The DSM, which is published by the American Psychiatric Association (APA), is used around the world by medical professionals, psychologists, researchers and even health insurance companies to classify and diagnose mental illness. The manual has undergone various changes since its first publication in 1952. Over the years, an increasing number of mental disorders have progressively made it into the manual, with many being removed as well. The most famous case of this is the removal of homosexuality from the DSM in 1986.

The DSM has been applauded for its attempts to standardise psychiatric criteria. The planned fifth edition (DSM-5) is due for publication in May 2013. However, the fifth edition has received more criticism than praise. The first draft, only recently revealed, has already caused uproar in the medical world for the risks it will pose.

Changes include the creation of a new category for “behavioural addictions”, with gambling as the only disorder in this group. Internet addiction was also considered for this category but there was insufficient evidence to prove that it could be categorised as a mental illness. “Hypersexual disorders” was also suggested as a new category. An individual is diagnosed with the disorder if he or she masturbates excessively and responds to stress or feelings of sadness by watching pornography or performing any other similar sexual activity. In order to be diagnosed with hypersexual disorder, the abovementioned behaviours must persist for six months or more, interfere with daily life activities and the individual must have tried numerous times to quit the behaviour. There should also be evidence to prove that the disorder was not caused by medication or recreational drugs. It is stressed that this disorder is not to be confused with sexual addiction – a proposal was made to include it which the APA rejected because it did not want to categorise sexual addiction with substance addiction.

A call to change the definition of depression is one of the most controversial aspects of the new edition including the reassessment of bereavement. News-Medical.net reports that under DSM-5, grief following the loss of a loved one will be considered a symptom of depression. “At the moment, depression is not diagnosed in the two months after [the] loss of a loved one,” says Randolph Nesse, a psychiatrist from the University of Michigan. “The result of this proposed change would be that people experiencing normal grief will receive diagnosis of major depression. Doing this would increase consistency in diagnosing depression, but at the cost of common sense. It is clear that bereavement is not a mental disorder.”

There is also a political and scientific storm brewing over the inclusion of sex-related diagnoses such as paraphilias (better known as sexual fetishes). Critics argue that sex offenders and rapists may exploit the law by providing an excuse for their behaviour, resulting in reduced jail sentences or “treatment” for their condition instead.

Shy or defiant children are also at risk of being unfairly labelled. The proposal to include what is currently known as “oppositional defiant disorder” could result in many parents diagnosing their withdrawn or disobedient children as mentally ill.

There is a strong belief among critics of DSM-5 that the creation of more diagnostic categories is due to the fact that there is financial incentive for pharmaceutical companies. This conflict of interest stems from what has come to be known as the “medicalisation of society”. In this type of society, all human problems are treated as medical conditions leading to people buying medication they don’t need. Critics maintain that it is obvious that this expansion of categories has financial motives.

Science in Africa reports that one in five South Africans suffer from some kind of mental disorder, with an increase noted among university students. There is no doubt that the DSM-5 will have an impact on South Africans.

Evidence suggests that the introduction of the DSM-5 may cause more harm than good in a society already plagued by disorders. A manual meant to help genuinely ill people could be undermined by false epidemics. Perhaps we should ask ourselves, as a society, whether we should support this kind of change in psychology.

Illustration: Ezelle van der Heever