DSM V and Thomas Szasz

Like many North American Psychiatrists, I have spent a good part of the past six months thinking about DSM V, The new Diagnostic and Statistical Manual of the American Psychiatric Association. Like DSM III and DSM IV before it, the new manual’s publication is giving rise to significant controversy that is likely going to set back the goal of decreasing the stigma surrounding psychiatric illnesses, their treatment, and mental health practitioners. Criticism against the manual is coming from such highly respected organizations as the British Psychological Society.

In reading through some of the negative opinion, I was taken back over thirty years to a time when Thomas Szasz’s The Myth of Mental Illness was causing a sensation among a number of mental health practitioners.  The Myth of Mental Illness was published in 1961 and Szasz was among those who were highly critical of the American Psychiatric Association’s manual:

“It is important to understand clearly that modern psychiatry – and the identification of new psychiatric diseases – began not by identifying such diseases by means of the established methods of pathology, but by creating a new criterion of what constitutes disease…Thus, whereas in modern medicine new diseases were discovered, in modern psychiatry they were invented.” (Italics are Szasz’s)

This is very similar to some of the concerns expressed regarding DSM V, and, behind the debate, one senses the same emotional response that many had to Szasz’s seminal work. At the time, those who included psychiatry as one of the medical sciences could be disturbed by reading Szasz’s work since he expressed so authoritatively exactly the opposite view.

With this in mind, consider this statement from the Open Letter to the DSM-5:

“We thus believe that a move towards biological theory directly contradicts evidence that psychopathology, unlike medical pathology, cannot be reduced to pathognomonic physiological signs or even multiple biomarkers.”

Reference: http://www.ipetitions.com/petition/dsm5/

When I have skimmed DSM V, and read the introduction, I was struck by the expressed strong desire of the authors to address psychiatric diagnosis scientifically. It seemed to me that the intent was that mental illnesses would be illnesses with as much validity as all other medical illnesses, leaving behind the credibility gap of the past, when mental illness, by virtue of being “less worthy” than physical illness, led to stigmatization.

It is a long time since I have thought about Thomas Szasz. To me, he was one of the forces that upheld stigma by emotionally focusing on those circumstances where there were uncertainties in an attempt to persuade that authoritarianism was more important in psychiatry than science. The visceral, emotional reactions to DSM V also seem tinged with belief more than science, if indeed science is an objective pursuit.  Read the Open Letter and then go to The Thomas S. Szasz, M.D. Cybercenter for Liberty and Responsibility ( http://www.szasz.com/) and see how they compare to you.

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