The complexity of human behaviour is closely related to the multifaceted nature of mental health disciplines. There are several propositions and varied focus on how to perceive mental health and to create standards which recognise symptoms and diagnose patients. Two proposed standards have roots in the development of medicine, psychiatry, and health statistics: the DSM and the ICD. What are these manuals, and why are they so controversial?
The Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) is a handbook published in 1994 by the American Psychiatry Association used to diagnose mental health disorders or illnesses. This book is primarily used in Western society – particularly the US, Canada, New Zealand, Australia, and some European countries – as a guide for diagnosing patients for health professionals. This publication is a polemic and widely discussed topic in mental health and related areas, with many professionals questioning its validity, purpose and applications.
Historical Development
The development of the DSM traces back from 1952, when the DSM-I was first published, containing about 106 classifications of mental health disorders. In 1968, the DSM-II was published. The first two editions were strongly influenced by a psychodynamic approach, which provides no particular contrast between the concepts of normality and abnormality. The DSM-II provided one of the most polemic diagnoses of the book’s history, when it included homosexuality as a mental disorder. Such decision evoked various protests and it resulted in a plebiscite which decided to remove the diagnosis in 1973. In 1980, the first ‘biomedically’ modelled DSM was published: the DSM-III. The DSM-III created a clear distinction between normal and abnormal, resulting in a more defined criteria as to whether diagnose and treat a patient suffering from specific symptoms. In 1986 the DSM-III was reviewed and it evolved into the DSM-III-R. The DSM-IV, which is the current version of the book, was first launched in 1994. However, the most recent version is the revised DSM-IV-TR. The APA expects to launch the next edition of the DSM around 2010: the DSM-V.
Problems with the DSM-IV
The DSM has been widely criticized in the mental health community. The validity of the classification criteria used by the handbook has been discussed, particularly when defining normality, discussing culture-related mental health problems, and using a fixed set of characteristics for diagnosis. Criticizers of the APA’s publication affirm that the major issues of the DSM-IV are: (a) the categories lack independence and are too heterogeneous (co-morbidity high, overlapping criteria for diagnosis); (b) aetiology is not considered (principles underlying categories are diverse); (c) there is low reliability (consistency) and low conceptual validity (correctness); (d) the classified disorders are mainly based on prevailing cultural view; (e) classification and labeling has potentially harmful consequences; (f) and there is the prevalence of political agendas represented by ‘medicalising’ life problems (marginalization of sections of society, drug companies, etc).
Manuals and Controversy in Mental Health: Part One
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