In 1952, the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-1) was published by the American Psychiatric Association. It lists and defines all mental illnesses. The fifth edition of DSM will come out soon. In 1952, 106 disorders were described. In every edition, the number has increased. The most recent edition, DSM-4, listed over 300 mental disorders, and DSM-5 promises to list many more than that.
So why have the number of mental illnesses more than doubled in the last half century? The word you are looking for here is “medicalization”. Medicalization means taking something and renaming it a medical issue. Do you have trouble sleeping after drinking coffee? The problem isn’t your error in judgement when you went to Starbucks at 9 pm. You have a medical disorder, Caffeine Induced Sleep Disorder (292.89). If you are fretting about how shy you are while you are tossing and turning in bed, you may have Social Phobia (300.23). But if instead you find yourself thinking about your place in the cosmos, or why we are here, you’ve got a case of V62.89 – Religious or Spiritual Problem.
So what? Why does it matter that doctors invent a medical code for every human condition? It matters because those codes mean that they can prescribe a medication to treat the disorder. And drugs are not actually always the best way to treat being human. The medicalization of life does not improve life for patients, it improves life for pharmaceutical companies.
If your child talks back to you – 313.81, Oppositional Defiant Disorder. And what we once thought of as sibling rivalry is now V61.8, Sibling Relational Problem. The difference is significant. Sibling rivalry might be treated with a light scolding, or maybe a time out, or perhaps mom might plan on spending some time with each kid individually to reduce the tension. Sibling Relational Problem is treated with a psychoactive drug.
Does your child dislike math? Uh-oh, that sounds like 315.1, Mathamatics disorder. If your teen in uncertain about her goals and plans, you have a case of 313.82, Identity Problem. Don’t even ask about the variety of relationship issues that have now become medical issues. The truth is that if you were trying to make up silly, nonsensical “illnesses” to make fun of DMS-5, you would have a very hard time finding any they missed.
Drugs all have side effects. While they may be necessary in some instances, there is always a benefit/cost factor. They should not be the very first thing you turn to to deal with every issue that might arise in life. But also, by telling people that they are “sick” if they are shy, or confused, or upset over something, is simply untrue. In the absence of drug treatments, people learn coping skills and strategies for dealing with ups and downs. If you are lucky, you even use the challenges of life to dig a little deeper into who you are, to learn to know yourself better, to improve yourself. We normally can begin to learn these skills, which will serve us again and again throughout life, in our teens. But teens and young adults who have been medicated for every issue as children tend to turn to medications exactly when they would have been learning how to deal with challenges.
DSM-5 is certainly silly and ridiculous. But it is also bad news for the mental health of the nation.