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October 22, 2013 at 9:01 AMComments: 0 Faves: 1

Unlocking the DSM-V: Diagnoses or Labels?

By Jeffrey VanWingen M.D. More Blogs by This Author

A few months ago, a much anticipated book was finally released. It wasn't a surprise Harry Potter novel or the next installment in The Twilight Saga; it was the fifth rendition of a book commonly referred to as the "Bible of psychological diagnosis," the Diagnostic and Statistical Manual V (DSM-V). People didn't camp out at bookstores to get fresh copies, but volumes of opinions and commentaries have been generated by this controversial compilation, which, in a nutshell, puts mental problems into boxes and gives them labels. Obviously, I have mixed feelings.

The Good and the Bad

Psychology and psychiatry have a difficult rap to overcome. Often referred to as "shrinks," they struggle to swim in the stream with other medical fields. With the stigma attached to diagnosing largely intangible disease processes, a method or standard is a necessary pillar for practice. Enter the DSM

This guide offers clinicians a framework for diagnosing all recognized psychological diseases. As such, it allows clinicians to communicate with their patients about various ailments. This opens a can of worms, however, when dealing with these sorts of problems.

The guide is user-dependent, leaves a lot of wiggle room depending on the clinician, and has been criticized by the British system for its "medicalization" of many behaviors that could be considered normal reactions to stress or trauma. And while standardization can yield consistent treatments, there is criticism that the pharmaceutical industry has a hand in the DSM formulation to encourage diagnoses that are treated by certain branded medications. Beyond clinicians communicating with patients, these diagnoses play an important role in billing, as insurance companies demand a diagnosis as a basis for payment. 

What's in a Name?

Major depression, generalized anxiety disorder, obsessive compulsive disorder, bipolar disorder, borderline personality disorder - these are some common diagnoses that circulate throughout the mental health arena. Sometimes, they're listed right along side a patient's name, age and sex. As such, they become a part of the persona and bear strong implications as to how a person is treated. Depressed people just have a poor outlook. An excited bipolar must be manicShe's a borderline, don't believe most of what she says

One of the reasons for the evolution of the DSM classifications is the emerging derogatory connotations with some diagnoses. Terms such as "retarded" and "borderline" are fading from the language, as they've been adulterated by common culture. Sometimes, it goes the other way. It was uncanny how many young women were diagnosed with bipolar disorder in the months after Brittany Spears received her diagnosis. 

Social or Scientific?

While there is an undeniable social component to mental illness, a scientific basis is factual - the nurture and the nature. Really, four neurohormones play into and balance our mood:

  • Serotonin
  • Acetylcholine
  • Dopamine
  • Norepinephrine

When one or more of these neurohormones if out of balance, disordered moods can follow. Sometimes social factors play, enhance, or even trigger these imbalances, and sometimes they don't. These hormones, and their predictable deficiency syndromes, form the basis of our understanding of medicinal therapy.

The Bottom Line

Basically, people/patients with mental disorders deserve better. From society, they deserve an understanding regarding the legitimacy of their affliction. From the medical community, they deserve care without prejudice based on a diagnosis or a label. This can start by seeing people at their face value and recognizing the DSM for what it is - an imperfect framework with the potential to yield common ground without bestowing tags.

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