February 10, 2012
http://www.guardian.co.uk/society/2012/feb/09/us-mental-health-manual?newsfeed=true
Psychologists fear US manual will widen mental illness diagnosis
Mental disorders listed in publication that should not exists, warn UK
experts
Sarah Boseley Health editor
guardian.co.uk, Thursday 9 February 2012 22.31 GMT
Hundreds of thousands of people will be labelled mentally ill because of
behaviour most people would consider normal, if a new edition of what has
been termed the psychiatrists' diagnostic bible goes ahead, experts are
warning.
Psychiatrists and psychologists in the UK are speaking out against the
publishing of DSM-5, an updated version of the Diagnostic and Statistical
Manual that categorises every type of mental disorder, including some that
the psychologists say should not exist.
A petition condemning the new manual circulated by psychologists in the
United States attracted 11,000 signatures. Its predecessor, DSM-4, is used
in research worldwide, and has an influence, for example, in naming
conditions that pharmaceutical companies devise drugs to treat.
However, the DSM's influence is uniquely strong in the United States, where
the private healthcare system requires a diagnosis recognised by the manual
for the patient to be considered legitimately ill and be reimbursed by the
health insurer for any treatment.
Among the anxieties to be labelled mental disorders if DSM-5 is published
in May by the American Psychiatric Association are shyness in children and
uncertainty over gender. Loneliness could attract a diagnosis of chronic
depressive disorder, and so could unhappiness following bereavement. A
serial rapist could be classified as mentally ill, given a diagnosis of
paraphilic coercive disorder.
Under the DSM-4, last revised 12 years ago, children who argue and refuse
to obey parents can be classified as having oppositional defiant disorder.
Professor Nick Craddock, consultant psychiatrist in Cardiff and director of
Wales' National Centre for Mental Health, said: "Somebody who is bereaved
might need help and even counselling, but they did not need a label saying
they had a mental illness. I believe that a large proportion of
psychiatrists in the UK and Europe are sceptical about DSM-5."
Peter Kinderman, professor of clinical psychology and Head of Institute of
Psychology at the University of Liverpool, said the revisions "could only
make a bad system worse". The diagnostic approach, a tick-box list of
symptoms leading to a label, was always "hugely problematic", he said. What
is termed "oppositional defiant disorder" is dubious, he said: "Since my
children say 'no you are an idiot, dad' repeatedly to me, by definition my
children are ill." He also disagreed with the label of paraphilic coercive
disorder: "In my view, rape is a crime and should not necessarily be
regarded as a disorder. It gives people an excuse for that behaviour," he
said."
Til Wykes, professor of clinical psychology at Kings College London, said:
"The proposals in DSM-5 are likely to shrink the pool of normality to a
puddle with more and more people being given a diagnosis of mental
illness."
The American Psychiatric Association strongly defends DSM-5. In response to
criticism from the British Psychological Association last year, Darrel
Regier, ice-chair of the DSM-5 task force. wrote: "While we agree that
human feelings and behaviors exist on a spectrum that contains some overlap
of normal reactions to disease states, psychiatry also recognizes that
there are real and discrete disorders of the brain that cause mental
disorders and that can benefit from treatment."
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Suzy Chapman
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