DSM-5 Rewrites Normal

A psychiatrist argues that the newly revised manual of mental disorders is part of a dangerous trend toward the medicalization of normal behavior.

By | May 20, 2013

FLICKR, SLETTVETAfter a 14-year revision process, the American Psychiatric Association last weekend (May 18) published the controversial 5th edition of its Diagnostic Manual of Mental Disorders (DSM-5). The influential book is designed to help doctors more reliably diagnose mental illnesses and guide treatments, but the latest version has come under heavy fire—with many critics arguing that by applying medical labels to experiences and behavior that were previously considered normal, the changes embodied in DSM-5 will lead to over-diagnosis and mistreatment.

Among the most high profile critics is Duke University psychiatrist Allen Frances, author of Saving Normal and chair of the task force behind DSM-4. In an excerpt from his book published at Wired, Frances contended that DSM-5 continues a trend toward the homogenization of people—a trend driven largely by the pharmaceutical industry’s attempts to reduce differences in behavior into easily categorized mental illnesses that require treatment with psychiatric drugs.

“With an assist from an overly ambitious psychiatry, all human difference is being transmuted into chemical imbalance meant to be treated with a handy pill,” wrote Frances. On the contrary, he added, “human difference was never meant to be reducible to an exhaustive list of diagnoses drawn carelessly from a psychiatric manual.”

Like many other critics, Frances is concerned that the latest version of the DSM transforms people who are basically normal into patients. For example, kids who have extreme temper tantrums will be diagnosed with “disruptive mood disorder,” and people suffering with grief will have “major depressive disorder,” which is typically treated with anti-depressants. For Frances, this represents a dangerous overreaching of psychiatric diagnosis that must be reigned in.

“People and policymakers may eventually wake up to the fact that we are not a bunch of sick individuals, each of us having a bunch of psychiatric diagnoses . . .” Frances wrote. “This is a myth generated by an overly ambitious psychiatry and a remarkably greedy pharmaceutical industry. Most of us are normal enough and would like to stay that way. We can ‘save normal’ only by ‘saving psychiatry,’ and we can save psychiatry only by containing it within its proper boundaries.”

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Avatar of: Brian Hanley

Brian Hanley

Posts: 36

May 20, 2013

No kidding. DSM began as a system that arbitrarily made diseases out of defined boundaries to conditions. It had its place, because psychiatrists of the time had no standard - they could define someone as mentally ill without any criteria at all.  But DSM is to a great degree a cultural document, not a scientific one, and always has been. Today,  DSM has over-developed, and is a highly political process. It always has been political in the sense that psychiatrists with more clout could get their suggestions into it, while others could not. As Frances points out, the strongest lobbying today is probably from pharmaceutical companies. 

Avatar of: FJScientist


Posts: 28

May 20, 2013

At some point, there will not be a single 'normal' person left in the world. But we all will be medicated so that we're all the same! What a paradox.

I am worried in general about overemedication for all diseases. But the medication of non-life-threatening differences amongst people is very disturbing. We've already reached the point where children now are medicated, in mass, in a misguided effort to control the normal explorations that are essential for allowing the child to grow into a productive, enquisitive adult. A rambunctious child is as important as the 'well-behaved' to the dynamic learning process that is childhood. We're conducting an experiment with potentially long-term consequences--some may argue for the good, but I am dubious about that.

There are many to blame for the current condition in which we apparently are trying to homogenize children, and adult, behavior. Yes, some blame rests with the pharmaceutical industry's profit motive. And professional bodies that act more as advocates for themselves rather than for the patients (or in this case, persons who never should be patients) are, in my opinion, unethical (that is really the heart of the DSM discussion, isn't it?). But ultimately, I blame a culture that applauds the elimination of personal differences over the rejoicing in our differences. I happen to believe strongly that those differences represent the engine that drives humanity. I am anxious about a future in which we are all behavioral clones.


Avatar of: James V. Kohl

James V. Kohl

Posts: 481

May 20, 2013

Old Efforts to get others to understand the problems with psychiatry:

Kohl (2012) "The gene, cell, tissue, organ, organ-system pathway is a neuroscientifically established link between sensory input and behavior. Marts and Resnick (2007) stress the importance of this pathway in the context of a systems biology approach to pharmacogenomics. Naftolin (1981) stressed its importance to the understanding of sex differences. This pathway is sensitive to conditioning. Sensory input from an organism's environment activates and reactivates the pathway and causes changes in hormone secretion that condition hormone-driven behavior."

"The FDA Critical Path Initiative

Given the importance of understanding how food odors and nutrition epigenetically influence individual survival in other mammals, it is not surprising that a reiteration of the ‘FDA Critical Path Initiative’ (Marts & Resnick, 2007) stresses the need to approach the development of human sexual behavior, which is required for our species survival and beneficial to human well-being, by using the same pathway that links food odors and pheromones to the behavior of honeybees and humans."

"Integration of olfactory/pheromonal conditioning into clinical psychology: The American Society of Addiction Medicine (ASAM) policy statement

The Public Policy Statement: Definition of Addiction (ASAM, 2011) represents a paradigm shift that may move the current practice of clinical psychology forward. It dictates the adoption and integration of neuroscientific principles that are required in order to understand differences between genetically predisposed brain disease, naturally occurring variations of behavioral development, and choice. These neuroscientific principles include focus on how sensory input influences behavior. The statement specifically mentions food and sex along with drugs and alcohol; each seems to chemically condition changes in hormones and in behavioral responses."

The RDoc includes all of the above, which is why the NIMH statement was predictable.


Excerpts from: Kohl, J.V. (2012) Human pheromones and food odors: epigenetic influences on the socioaffective nature of evolved behaviors. Socioaffective Neuroscience & Psychology, 2: 17338.

Avatar of: VXIII


Posts: 2

May 21, 2013

We will all soon be on Soma like pills like in The Brave New World

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