Anne Cooke

DSM: Get your hernia belt
on for the fifth edition.

One thing I like about being a psychologist is that you get the occasional call from journalists asking interesting questions. The one who phoned the other day was making a radio programme about new mental illnesses. She was referring to the soon-to-be released fifth edition of the diagnostic ‘Bible’, the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association). This newest version is set to classify even more experiences and behaviours as ‘mental disorders’ than its predecessors. For example, binge eating is to become a disease, and in future you may also need expert treatment if you spend too long in front of your computer (‘internet addiction’). Each edition of the DSM introduces us to new diseases. The first edition, published in 1952, was 132 pages long. The 1987 edition (DSM III-R) was 569 pages. By the time the current edition was published in 2000, it had swelled to 943 pages. I wonder how many pages long DSM-V will be, and how many strong men it will take to lift it.

What we often lose sight of is that calling certain emotional states, or ways of thinking and acting ‘mental illnesses’ is just one way of thinking about them, rather than the only way. All we really know is that people sometimes feel or act in certain ways. For example, if I feel sad and hopeless, and stay in bed all day staring at the ceiling, I am likely to be diagnosed with depression. I may be told that I have an illness, and this way of understanding my situation does have its advantages. I can go to my GP and hopefully find a sympathetic ear, maybe some tablets to take the edge off things and perhaps be referred on to someone I can talk to. If I’m feeling so bad that I can’t work, I can take time off sick and even claim benefits. So the idea of mental illness definitely has its plus sides: it gives us a way of talking about difficult things and a framework for offering help. However, I often wonder whether overall, the whole enterprise of finding medical labels and drug ‘treatments’ for what are often arguably problems of living, or in some cases lifestyle choices, actually causes more problems than it solves. To continue the example, thinking of myself as mentally ill might well be a huge blow to my self-confidence. I might conclude that there is little I can do to help myself except to keep taking the tablets. Depending on my diagnosis, I might begin to fear turning into people’s image of a mental patient – strange, unable to function and perhaps even potentially violent. Other people who know that I am ‘mentally ill’, might be prejudiced and treat me as inferior or even frightening. I would find it harder to get a job and, as someone once said to me, “I’m mentally ill” is hardly the best chat up line is it?’ I would also lose some of the human rights I had always taken for granted: people with ‘mental disorders’ are the only group that can be locked up without trial and injected with drugs against their will.

A pill for every ill? So what might
greater diagnosis mean?
I have written about this issue in more detail elsewhere. So have several of my colleagues, and the British Psychological Society has expressed its concern that ‘clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences’. However, I sometimes wonder whether logical argument is likely to change anything when there are so many vested interests at stake on all sides. Individually and as a society we want, or perhaps need, to believe that professionals and technology have the answers. It’s also clear that the mental health industry certainly isn’t going to argue. The American Psychiatric Association profits very directly from the idea that certain experiences are diagnosable ‘illnesses’. It makes millions of dollars every year from its monopoly on DSM, and the new edition will sell for $199, more than double the price of the current edition. Drug companies profit only slightly less directly: GlaxoSmithKline paid vast sums to its PR company to publicise little known DSM ‘diseases’ after its drug Seroxat, previously marketed as an antidepressant, was licensed to treat them: first ‘social anxiety disorder’ (hitherto known as shyness), and then ‘generalised anxiety disorder’’ (see a further interesting discussion here. I wonder if ‘internet addiction’ will be treatable with Seroxat too. 

So it looks as if most of us are likely to go on believing the DSM story, perhaps concluding, in the words of someone recently interviewed in our research, that we’re ‘sicker than we thought we were’. 

Links for more information Clinical Psychologist Lucy Johnstone discusses alternatives to diagnosis. Check out the main website ( while you’re there.