There is a lot of pain and suffering in the world, and it is tempting to believe that the mental health community knows how to help. It is widely believed, both by mental health professionals and the general population, that if only a person gets the right psychiatric diagnosis, the therapist will know what kind of measures will be the most helpful. Unfortunately, that is not usually the case, and getting a psychiatric diagnosis can often create more problems than it solves, including a lifetime of being labeled, difficulties with obtaining affordable (or any) health insurance (due to now having a pre-existing condition), loss of employment, loss of child custody, the overlooking of physical illnesses and injuries because of everything being attributed to psychological factors, and the loss of the right to make decisions about one’s medical and legal affairs. The creation and use of psychiatric diagnosis, unlike, for instance, psychiatric drugs, is not overseen by any regulatory body, and rarely does anyone raise the question of what role the assignment of a psychiatric label has played in creating problems for individuals.[ii]
The Problematic History
Contrary to popular belief, the enterprise of psychiatric diagnosis is largely unscientific and highly subjective (Caplan, 1995; Caplan & Cosgrove, 2004). Therapists often disagree about which label to assign to a given patient, and there is perhaps surprisingly little definitive research to prove that, “A person with diagnosis X will benefit from and not be harmed by treatment Y.”
These serious limitations have not prevented the authors of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM), sometimes known as “the therapist’s Bible,” from making expansive claims about their knowledge and authority and wielding enormous power to decide who will and will not be called mentally ill and what the varieties of alleged mental illness will be. The DSM’s current edition is called DSM-IV-TR, and it was preceded by the original DSM (in 1952), then DSM-II (1968), DSM-III (1980), DSM-III-R (Third Edition Revised) (1987), DSM-IV (1994), and DSM-IV-TR (2000). The DSM-V is currently in preparation and slated for 2013 publication. Each time a new edition appears, the media ask whichever psychiatrist is the lead editor why a new edition was necessary, and like clockwork, each editor replies that it was because the previous edition really wasn’t scientific (Caplan, 1995). And each time a new edition appears, it contains many more categories than does the previous one. For instance, DSM-III-R contained 297 categories, and DSM-IV contained 374 (Caplan, 1995).