The Art of Diagnosis (B1, Mika and Remmy)

The APA is publishing the DSM-V in 2013. Many disorders, including PMDD (Premenstrual Dysphoric Disorder), addiction, compulsive buying disorder, and apathy disorder, will be added by the DSM-V Task Force into the DSM-V. The central TOK issue raised in the article is the language issue of defining abnormality or normality. The AoK involves human sciences because the DSM-V is based on human behavior.

The advantage of adding all the disorders is that it is a means for the systematic categorization of mental disorders. By categorizing mental disorders, every psychiatrist would be able to consult the same book to make diagnosis instead of relying on his or her opinions. In other words, the DSM put a name to symptoms of a mental disorder and provides structure for the diagnosing of mental disorders.

On the other hand, the disadvantage is that DSM doesn’t draw a clear line between a pathological disorder and an idiosyncratic behavior. It’s difficult to explicitly claim that one behavior is normal and the other isn’t. For example, some symptoms of PMDD are sadness and anxiety. They are arbitrary and may be experienced by everyone. Also, lot of times, the symptoms of mental disorders have certain timelines (i.e. “if you’re depressed for over two weeks....”), but who defined that (i.e. why two weeks instead of three)? Another disadvantage is that the disorders are stigmatizing; labeling people could lead to self-fulfilling prophecies and seclusion. Lastly, the validity of the DSM should be considered. Every publication of DSM is thicker than the preceding one, and the widening scope of disorders makes us question if the DSM is accurate and all of us crazy or sick, or if the DSM is written in favor of certain authorities, such as drug industries in the ‘60s.

Despite the questionable validity of such a classification system of mental illnesses, the benefits of DSM-V (or DSM in general) outweigh the disadvantages, because it provides a standardized way for people to understand their own behavior as well as one another’s. Although DSM may not be accurate in drawing the line between abnormality and normality, it is still better to be precise and not accurate than it is to be neither precise nor accurate.

Branching off, the language issue of defining abnormality and normality brings an interesting question: can life in general be defined by words? Language is a human tool used to label the world around us and to communicate with one another. However, it is an imprecise tool. Often times, the words we use are not an accurate depiction of what we are thinking. Just as a map is not a precise representation of the territory, language is an imprecise representation of our thoughts.

Similar to the DSM-V case concerning language barriers, Caster Semenya also had trouble with questions about her gender during the 2009 World Championships. It was questioned whether Caster Semenya had a physical condition that gave her an advantage over the other competitors. The question the issue raises is, how should gender be defined? Or, in the grander scheme of life, how should anything be defined, when so few things are clearly this or clearly that and everything else falls in between?

The Problem with DSM (IB Psych) - Kali, Monica, Anna

The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, is a book cataloging all “mind-based maladies designed by the American Psychiatric Assocation” (On the Media). The podcast questions the validity of the DSM, as well as the definition of “abnormality” - what is “abnormal enough” to be included in the DSM? The latest edition of the DSM, DSM V, is being published in 2013 and the first draft was recently released by the American Psychiatric Association for public criticism and comment. Many questions can be raised about the DSM. How do you define abnormality and normality? Can humans be categorized? Does the book cover disorders from all different types of ethnicities?

A problem with the DSM is that it cannot distinguish what is “normal” and what is “abnormal”. The definition of “abnormal” and “normal” is a serious issue that is always up for debate. The power of a word can make a significant change to a man’s life; but if there isn’t an exact definition of the word, how can we predict the level of impact on that person? Even though we have a preferred definition for our daily language, but when it comes to “a word with 2 definitions” or words that sound similar, there is no formula that tells you which one to use at the right moment. Since we usually pick the word that is most suitable for that specific situation, then what if a similar situation occurred but with some slight changes, is that word still suitable, or should it be implied with a different meaning?  For instance, a common question asked in court is, “Is he/she guilty or not?”, the word guilty, can be implied in many different way. First, the definition of guilty doesn’t have an exact definition. For example, if not finishing your food on the plate is considered a severe level of guilt and that it would cost your life, then, if a man robbed a convenient store, does that mean that he should be prosecuted right away? Also, another definition of the word “commitment” can be varied in many different situations. For instance, in a relationship, if you are committed do another person, does that mean that if you were to spend more time at work and not on your family, you are not a committed person? So, all the married people who are committed to work are not a good spouse? All words imply something different. We create words and give it “semi-exact” definition because they are essential for communication; but when it comes to different people using their own sets of mind analyzing a word in different situations, the final message coming from the brain will differ for everyone; that beings said, nothing is the same, it is only the published books and wireless internet that gives you the illusion that all words have an exact interpretation to it.

An example is homosexuality, which wasn’t taken out of the DSM as a psychological disorder until 1986 (Mofas). That means that homosexuality wasn’t “normal” until 25 years ago. What is normal? Does it depend on the culture? Many cultures have different ideas of what “normal” is. If there are different opinions of what “normal” is, then does “normal” exist? Normality is relative, we need a standard scale for this kind of subjectivity. The disorders DSM provided seem like usual human characteristics, just on different levels. But what level is too much and who is to say that that is the scale to follow to? And, if something is in the DSM, does that mean it’s not normal? There is also an issue of what to put in the DSM when it is being revised.

Now that our society has changed, internet addiction or maybe even pornography addiction might be able to be added to the DSM. In my opinion, I do think those should be added to the DSM because it does affect some peoples’ daily lives. However, I wonder if in the future, when computers are even more widely used than today (i.e. every student in America has to bring a laptop to school), if internet addiction would be considered a psychological disorder. Perhaps people in the future will laugh at how it was a disorder, and it might seem so silly to them.

So, I think that although the DSM is not completely reliable, it is good that it is being revised because our society does keep changing. However, I think that the DSM should be revised more often. In the past, it has been revised once every 6-16 years. Thankfully, according to MOFAS, the DSM should be revised more often after the publication of the most recent one, DSM-V. The DSM does have another issue, though. At times, the symptoms for some disorders may be found in some people who shouldn’t be diagnosed with that disorder. I can find some symptoms of depression in myself, but I wouldn’t say I suffer from depression. Many people I know claim to have a psychological disorder, such as ADHD, and claim to be taking medication for it, but their actions seem to be more as a result of being an immature teenager than someone diagnosed with ADHD. This is an issue brought up by Dr. Jonathon Metz. People go to the doctors and claim to have a particular disorder or disease and ask for medication, and the doctor approves it. He says that “what happens over time is that the diagnostic boundaries expand and expand and expand, so that a drug that was indicated for a very small subset of people over time becomes indicated and used for a much wider category”.

Sometimes it can even seem like the DSM makes it so easy for patients to go to a doctor and say they think they have a specific disorder, and the doctor can easily agree. People might also take advantage of claiming him or herself of having a disorder and not take responsibility in his or her own actions.So, what the DSM shouldn’t cover is how many symptoms one must express  and/or how severe their symptoms must be in order to be considered for diagnosis for a disorder.