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This “Now-you-see-it, now-you-don’t” phenomenon didn’t begin with the latest revision. Until 1974, for example, homosexuality was listed as a mental illness, and this was validation enough to support research grants to study the “disease” (and recommend such “cures” as shock therapy and behavior modification). As represented in the book comprising the accumulated wisdom of the best scientists and clinicians in the field of mental health, the diagnosis wasn’t an opinion — it was a fact.
Until it wasn’t. Homosexuality was removed from the DSM as the result of negotiations between the task force and the gay and lesbian community, which had been protesting the APA and its bible for years. Greenberg says the removal of homosexuality from the DSM was revealing, suggesting that “even when psychiatrists did agree on a diagnosis, they might have been diagnosing something that wasn’t an illness.”
The APA’s own psychiatrists acknowledge privately that the disorders the DSM so carefully and methodically arrays, like butterflies pinned to a board, aren’t real — or if they are, no one can prove it. In the absence of a single biological or chemical test that can verify their existence, what gets called a mental illness is likely to be, instead, a manifestation of the era’s cultural biases.
As Greenberg points out, doctors today “diagnose with Hoarding Disorder people who fill their homes with newspapers and empty pickle jars, but leave undiagnosed those who amass billions of dollars while other people starve.”
“Here’s the problem,” Allen Frances, who chaired the task force for the DSM-IV, told Greenberg: “There is no definition of a mental disorder. It’s bulls—t.”
This, then, is the profession’s dirty little secret: For all their confident pronouncements and scientific-sounding language, “psychiatrists [don’t] seem to know the difference between sickness and health.”
The battle over “bereavement” illustrates this perfectly. Bereavement looks like major depressive disorder, and yet it is an inevitable and normal part of life. After endless discussions, psychiatrists working on the DSM-III contrived the “bereavement exclusion,” which specified that bereavement, although it replicated MDD in every way, was not a disorder unless its symptoms had not dissipated after two months.
Thirty years later, however, doctors working on the DSM-5 saw it differently. Now, if you manifest symptoms of depression two weeks after the death of someone you love, you are suffering from major depressive disorder.
As the previous DSM chair, Frances could see the DSM-5 process hurtling toward disaster. After all, he had made several egregious errors with the DSM-IV and didn’t want to see them repeated. Perhaps his worst error was lowering the criteria for childhood bipolar disorder, which ignited a diagnostic epidemic. In 1994, less than half of 1% of all children with mental illnesses were bipolar. In 2003 that number was 6.67%.