LONDON (Reuters) - Millions of healthy people - including shy or defiant children, grieving relatives and people with fetishes - may be wrongly labeled mentally ill by a new international diagnostic manual, specialists said on Thursday.
In a damning analysis of an upcoming revision of the influential Diagnostic and Statistical Manual of Mental Disorders (DSM), psychologists, psychiatrists and other experts said new categories of mental illness identified in the book were at best “silly” and at worst “worrying and dangerous.”
“Many people who are shy, bereaved, eccentric, or have unconventional romantic lives will suddenly find themselves labeled as mentally ill,” said Peter Kinderman, head of Liverpool University’s Institute of Psychology at a briefing in London about widespread concerns over the manual.
“It’s not humane, it’s not scientific, and it won’t help decide what help a person needs.”
The DSM is published by the American Psychiatric Association (APA) and has symptoms and other criteria for diagnosing mental disorders. It is used internationally and seen as the diagnostic “bible” for mental health medicine.
No one from the APA was immediately available for comment.
More than 11,000 health professionals have already signed a petition (at dsm5-reform.com) calling for the development of the fifth edition of the manual to be halted and re-thought.
Some diagnoses - for conditions like “oppositional defiant disorder” and “apathy syndrome” - risk devaluing the seriousness of mental illness and medical zing behaviors most people would consider normal or just mildly eccentric, the experts said.
At the other end of the spectrum, the new DSM, due out next year, could give medical diagnoses for serial rapists and sex abusers - under labels like “paraphilic coercive disorder” - and may allow offenders to escape prison by providing what could be seen as an excuse for their behavior, they added.
Simon Wessely of the Institute of Psychiatry at King’s College London said a look back at history should make health experts ask themselves: “Do we need all these labels?”
He said the 1840 Census of the United States included just one category for mental disorder, but by 1917 the APA was already recognizing 59. That rose to 128 in 1959, to 227 in 1980, and again to around 350 disorders in the fastest revisions of DSM in 1994 and 2000.
Allen Frances of Duke University and chair of the committee that oversaw the previous DSM revision, said DSM-5 would “radically and recklessly expand the boundaries of psychiatry” and result in the “lexicalization of normality, individual difference, and criminality.”
David Pilgrim of Britain’s University of Central Lancashire said it was “hard to avoid the conclusion that DSM-5 will help the interests of the drug companies.”
“Madness and misery exist but they come in many shapes and sizes,” he said. “We risk treating the experience and conduct of people as if they are botanical specimens waiting to be identified and categorized in rigid boxes.
“That would itself be a form of collective madness for all those complicit in the continuing pseudo-scientific exercise.”
Nick Craddock of Cardiff University’s department of psychological medicine and neurology, who also spoke at the London briefing, cited depression as a key example of where DSM’s broad categories were going wrong.
Whereas in previous editions, a person who had recently lost a loved one and was suffering low moods would be seen as experiencing a normal human reaction to bereavement, the new DSM criteria would ignore the death, look only at the symptoms, and class the person as having a depressive illness.
Other examples of diagnoses cited by experts as problematic included “gambling disorder,” “internet addiction disorder” and “oppositional defiant disorder” - a condition in which a child “actively refuses to comply with majority’s requests” and “performs deliberate actions to annoy others.”
“That basically means children who say ‘no’ to their parents more than a certain number of times,” Kinderman said. “On that criteria, many of us would have to say our children are mentally ill.”
Editing by Andrew Heavens