Saving Normal?

March 4, 2010 at 10:24 am 3 comments

A recent opinion piece by Allen Frances for the LA Times is plainly pointing out the dangers of the new DSM’s broad strokes and the potential to paint too many “normal” people as mentally ill. It’s notable enough that mainstream press is presenting any criticism at all about psychiatry in general and the DSM in particular but Allen Frances was one of their own and no silent partner or low level underling either. He was the chairman of the committee that created the DSM-IV.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false “epidemics” — attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many “patients” who might have been far better off never entering the mental health system.

The first draft of the next edition of the DSM, posted for comment with much fanfare last month, is filled with suggestions that would multiply our mistakes and extend the reach of psychiatry dramatically deeper into the ever-shrinking domain of the normal. This wholesale medical imperialization of normality could potentially create tens of millions of innocent bystanders who would be mislabeled as having a mental disorder. The pharmaceutical industry would have a field day — despite the lack of solid evidence of any effective treatments for these newly proposed diagnoses.

Where the DSM-versus-normality boundary is drawn also influences insurance coverage, eligibility for disability and services, and legal status — to say nothing of stigma and the individual’s sense of personal control and responsibility.

It’s interesting to see someone in psychiatry addressing the notion of false epidemics of mental disorder when a committee decision and ever changing public opinion are all that separate a “real” epidemic from a false one. That said, committee decisions and public opinion have proven quite powerful and if you look back, the release of each DSM has brought on a rash of newly mentally ill. If history proves a good indicator, there will be millions of people who are normal today and mentally ill in 2013 — all thanks to a book with the power to categorize and medicalize the human condition. How much sorrow is too much? How excited can you be about everyday things before you are manic? And now with the proposed introduction of psychotic risk syndrome, anyone who isn’t deemed mentally ill can be subject to the book’s reach simply out of fear that they may be in time.

What are some of the most egregious invasions of normality suggested for DSM-V? “Binge eating disorder” is defined as one eating binge per week for three months. (Full disclosure: I, along with more than 6% of the population, would qualify.) “Minor neurocognitive disorder” would capture many people with no more than the expected memory problems of aging. Grieving after the loss of a loved one could frequently be misread as “major depression.” “Mixed anxiety depression” is defined by commonplace symptoms difficult to distinguish from the emotional pains of everyday life.

The media seldom addresses views critical of psychiatry but for psychiatrists to come out against the new proposals in such a public way is truly indicative of what’s at stake with the new DSM. You can bet that if psychiatrists are picking sides on this, it carries huge implications worth looking at. It doesn’t take much to see the power inherent in handing over our culture’s ability to define “normal” to a small committee comprised exclusively of people with something to gain and Frances is not exaggerating when he calls it “wholesale medical imperialization.” How much control are we willing to hand over? How far are we willing to let anyone go in defining us? How widely cast will the net be before it captures you? This is not an issue of special interest only to those marked as seriously mentally ill. Every label of mental illness is serious and with an ever broadening range of perceived illness encroaching upon a shrinking concept of normal, you may not be off the hook.¬†Frances’ article says that it may not be too late to save ‘normal’ but I question whether ‘normal’ is worth saving.

See also: Allen Frances’ Opening Pandora’s Box: The 19 Worst suggestions for DSM5 in Psychiatric Times.


Entry filed under: Psychiatry. Tags: , , , , , , , , , , , , , , , , , .

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  • 1. dogkisses  |  March 5, 2010 at 1:20 pm

    I love this post. I actually love all your posts and am glad you are here. I wish my brain wasn’t so tired so I could keep up on things the way you do — so I come here and let you help me keep up.
    I read a book many years ago that this post reminds me of. The author is Paula J. Caplan, “They say You’re Crazy.” She speaks to the DSM and WHO (World Health Organization ? ) decides who is crazy. At the time she wrote the book, in 1996, only a few white males decided.
    I don’t know how much things have changed since that book as far as WHO decides who is “crazy.” It is a great book in my opinion though and I see she wrote more in 2004.
    Your post also reminds me of when I lived in a town where there lived mostly artists, people seeking solitude in a natural environment (was in the beautiful mountains of NC), along with spiritual seekers and many many natural healers. I had to move but the cultural differences as to what is normal and what is a “mental illness” or “disorder,” is vastly different, even though the two places are only hours apart in driving time.
    My therapists up there were surprised when I told them I had been told I had a mental illness. They simply didn’t see my sadness as that. Where I live now, well, if you don’t wear a clean white shirt you may be labeled mentally ill.
    Thanks again for your continued work to share on this blog! It is very important and I think your blog is awesome!

  • 2. jbenick  |  March 5, 2010 at 6:20 pm

    Aaron, I love this post. I have to wonder though, why people are so accepting of and eager to take medication to help their ‘condition.’ Perhaps it’s a case of people not wanting to appear different if a group is pointing out their ‘flaws.’ Why is everyone afraid to stand out? I’m not saying people should necessarily learn to be happy with all of their traits, but there are certainly ways to work through things and change your behavior without looking to a group of people who use questionable methods of ‘treatment’ and who, individually, would likely fall under the descriptions of some of the ‘conditions’ listed in the DSM.

    Also, I was surprised to see this under the definition of ‘normal’: : of, relating to, or characterized by average intelligence or development b : free from mental disorder : sane

    It’s amazing how judgmental a group of theorists can be when they cannot even prove that most of these ‘disorders’ exist at all.

  • 3. marlborojones  |  March 6, 2010 at 1:37 am

    jbenick– I think one of the great tricks in life is not struggling to change one’s traits or behavior, but accepting them and learning how to turn one’s liabilities into assets.

    As for the definition of ‘normal,’ the last thing a world superpower should want in order to maintain its status is citizens of ‘average intelligence’ and people who never want to excel and who are smug about sittingt on the Bell Curve. Can an Idiocracy be far behind?


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