The Battle of the DSM

It’s not often I blog-post on psychiatry. But we all know what a massive part of medicine it is and will continue to be.

A key part of psychiatric practice is defining illness, and for this a diagnostic manual, known as the DSM is typically used. As explained in this article, the DSM has undergone many revisions since it’s inception in 1952. With each revision there are the usual diagnostic defining battles we expect in any area of medicine. But psychiatry is unique in that it borders the immaterial and questions of conscience, morals and human behaviour.

The writer of the article linked believes, as do many, that we are in danger of medicalizing many non-health issues. The main example he uses is that of racism. Unbeknownst to me, it seems there is a school of thought pushing to include racism as a form of psychiatric illness in it’s own right (I’m sure it is already a feature of many well-defined psychoses where the race-hatred is clearly associated with other erratic thoughts and behaviours).

There already exist many areas of medicine where psychiatric over-diagnosis is purported to occur. One area is postnatal depression. A study reported in the Journal of Affective disorders reports that it may be over-diagnosed in 50% of cases.

Another interesting feature of this article is the discussion about sexual mores. It seems some extreme practices such as bestiality are no longer considered a sign of mental ‘deviation’ – except where they impact on others in a clear way.