A Largely Uninformed Screed in Support(ish) of DSM-5

“That book would be like my heart and me / Dedicated to you”

                                                 –Zaret/Chaplin/Cahn, Johnny Hartman, Ella Fitzgerald, etc.

“It’s a poor craftsman who blames his tools”

–My eighth-grade shop teacher (although he probably stole it from somebody)

Depending on what source you consult, it’s either already out or will be out later this week, but the controversy over DSM 5 (and, yes, it’s Arabic number 5, not Roman numeral V, lest people get confused and think the APA is trying to cash in on publishing trends with the Diagnostic and Statistical Manual – Vampire Edition, soon to be followed by Werewolf, Xenomorph, Yeti, and Zombie editions) is already in full swing.  And regardless of its release date, the window wherein (wherethrough?) I can lob opinions and then claim ignorance of the source material as a means of justifying my eventually-recanted opinions is rapidly closing.

One of the main criticisms of DSM-5 is that it is entirely too influenced by pharmaceutical companies, leading it to be nothing more than a prescriber’s guide to rapid labeling of potentially non-existent mental illnesses, thereby justifying the distribution of medications to people who don’t really need them.  Something that people who make this argument often forget to address, though, is that the DSM-5 (and previous editions) also serves the purpose of providing a coding system so insurance companies have confusing numbers rather than actual explanations to use on the forms they mail out when they deny coverage for those medications.  The real test of your mental health care, then, becomes how good your doctor’s office is at submitting the right codes to ensure that you won’t have to pay too much for the medications you probably don’t need, and whether or not your doctor will give you whatever medications you try to convince her/him to give you based on something you saw in a commercial.

My cynical rejoinder to the above claim is: “No shit–the same basic process happened with medical health care. Why did you think it wouldn’t happen with mental health care?  And, really, why didn’t you realize that the pharmaceutical companies already largely instituted that process even without DSM-5?”

My completely naïve and hope-filled response to the above argument is:  “Well, actually, the DSM-5 (as with previous editions) is a tool intended to be used by professionals who are trained in mental health care, and who realize that, except in a relatively small number of very serious mental illnesses, pills are not going to function as the primary means of addressing those issues.  In the hands of these professionals, a diagnosis is more a means of trying to identify what is at the core of a person’s mental health needs, so there can be a common language to use when trying to figure out what kind of strategies might help the clients—only one of said strategies being the use of medications.”

But let’s be clear about a few things.  First, the majority of people working in the mental health field are NOT trained, qualified, or legally allowed to prescribe medications.  They fall into various categories of counselors, therapists, treatment providers, and social workers.  They are the ones who try to address mental health issues not with a pill, but through a complicated process of human interaction (ridiculous, I know, but I read somewhere that it can actually work).  Secondly, and perhaps more important to the current criticism of pharmaceuticals/pharmaceutical companies, the vast majority of people prescribing medications for mental health reasons are NOT adequately trained in mental health.  Arguably, most uses of medications to deal with mental health issues already involve a kind of crapshoot as to whether the medications will be effective, in what doses, and for how long.  And yet we compound this uncertainty by having primary care physicians, who, for example, see patients for eight minutes every three months, try to keep up with changes in patients’ mental health status by ‘tweaking’ said patients’ medications.

To be sure, DSM-5 is flawed, just as DSM-IV (that’s 4, not intravenous) is flawed, although perhaps in different directions.  I am not suggesting everyone in the mental health field fall in lockstep and adhere blindly to whatever is laid out in DSM-5.  But like every professional in every field knows (or should know), you use the tools you have, but with a critical eye, and a knowledge of the tools’ limitations.

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