The DSM and scientism

The American Psychiatric Association (APA) is planning a 2013 release of the next edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM). First printed in 1952, the manual has been a boon to the profession because it got all clinicians on the same sheet of music, and it provided diagnostic codes so that providers could bill insurance companies.

Technically, the manual is only a classification manual. It provides labels for all of the emotional and behavioral struggles that people experience. Currently there are over 400 different entries.

The problem with labels, though, is that they explain nothing. The DSM does little more than classify the symptoms that people experience and the signs that others observe. A diagnosis, on the other hand, infers that there is an underlying disease state that produces the symptoms and signs at hand. In psychiatry, there are no objective tests or biomarkers for mental disorders, a point recently admitted by a past-president of the APA, Dr. Carol A. Bernstein. In the same article, she complained that practitioners who use the DSM tend to “reify” the various classification labels; that is, they turn labels into real-world diagnoses. You won’t hear that kind of admission very often from within the field. Instead, you’ll hear that the new DSM represents a big step forward in science and then you can watch both practitioners and patients routinely reify those labels.

An example of how this works in the real world is as follows: a restless and fearless child who begins violating classroom rules (getting up out of his seat, talking out-of-turn, bullying others) will be sent to a mental health clinic where he’ll be labeled with Attention-Deficit Hyperactivity Disorder. When he begins fighting and setting fires, he’ll receive the label of Conduct Disorder. When he starts using drugs, he’ll be labeled with Substance Abuse Disorder, and when he begins to have volatile adolescent emotions, he’ll be labeled with Bipolar Affective Disorder. Along the way he’ll receive medications and talk therapies. Parents begin to see that their main job is to get their kids to therapy sessions and to make sure kids take their medications.

It shouldn’t be a stretch to imagine how children raised in this kind of label-driven, pharmaco-therapeutic climate might develop emotional and behavioral habits that keep them from becoming self-controlled, responsible adults. Indeed, they often become narcissistic, labile and entitled adults. It used to be that children who misbehaved were met with discipline and punishment, all of which was designed to make them self-controlled, responsible individuals. Fortunately, one can still find pockets where this kind of child-rearing takes place.

The rise of the DSM has correlated with a popular belief in scientism, which maintains that science is the only way to solve problems of the human condition. This faith is misplaced. Scientists are human beings, and human nature is nothing if not opportunistic. Common sense dictates that science has bounds, and when it oversteps, society can be harmed.