DSM-IV-TR and the Fallacy of Diagnostic Labels…

Jacobs, D., & Cohen, D. (2010). Does “Psychological Dysfunction” Mean Anything? A Critical Essay on Pathology Versus Agency Journal of Humanistic Psychology, 50 (3), 312-334 DOI: 10.1177/0022167809352008

Any behaviour that deviates too far from the norm must be a mental disorder, or so says the DSM-IV-TR (2009, p.313). And why is that? A long pause here, because the DSM does not actually provide an answer to that question, other than to suggest that someone who is totally out to lunch must be fully sick in the head, so there! Thus, the maddest thing that anyone could ever be is a pig ignorant adherent of the cult of DSM, tagging along, using all the big words, pulling out the inkblots, brain scans, head bumps, and twin studies, all with much sideshow but null evidence. A solitary fact, let alone a comprehensive evidence base are, after all, the main ingredients that the DSM lacks.

Jacobs and Cohen (2009) deliciously spray candy-coloured shite all over the tainted credibility of the DSM, lampooning its calls to objective science in the face of its complete lack of objectivity, judging as it does certain social behaviours harshly but then eschewing social causation, and pontificating from on high while excluding the lived experiences of actual sufferers (pp.314-315). It is the exclusion of individual agency, the real stories of men and women who have been different or distressed and yet who suffer that abuse, in some cases secondary abuse, of being caught within the DSM net, that most attracts the authors’ attention (2009, pp.314-315, p.320).

‘The accomplishment of PTSD as a psychiatric disorder has been to incorporate what might otherwise be construed as highly contentious human issues (waging war, preventable industrial accidents, interpersonal violence, etc.) into a medical pathology framework. It is true that an extremely negative personal experience must be disclosed to qualify for a PTSD diagnosis, but the “symptoms” are by definition regarded as “a manifestation of [an unknown] behavioral, psychological, or biological dysfunction in the individual”’ (2009, pp.323-324).

The authors refer specifically to the inanity of trying to squeeze subjective trauma into the DSM category of post-traumatic stress disorder (PTSD) (2009, p.323). In so doing, psychiatry can reconfigure cause and effect in the real world to ‘seek to discover’ in the ethereal world, that is, its bread and butter. However, the pain that war or other violence inflicts upon the minds of a myriad of individual subjects across space and time, cannot, and will not be so easily contained. Little surprise, then, that as a million mindless arseholes conjure up what will be in the DSM-V, whispers are that PTSD will be out, because its diagnostic criteria are not clinically robust!

Clinically robust? In a tome where almost anything goes, without a scrap of proof?

Where Jacobs and Cohen (2009) could have gone further, in my view, would have been to detail how the DSM inflicts untold misery and harm upon people whose only ‘crime’ was to be different. I have never seen anyone benefit from having a diagnostic label slapped upon them, but I have seen hundreds of lives destroyed by being recast as ‘schizophrenic’, ‘depressed’, ‘borderline’, etc… From a therapeutic perspective, the greatest tragedy of the DSM, in practice, is that it disallows health professionals to step outside of a rigid, nonsensical nomenclature and learn how to ‘discover’ who the person is before them (2009, p.328)…

  1. June 17, 2010 at 11:31 pm | #1

    A week ago I’d have taken offense at this. I may not take pride in my mental illness diagnoses, but it’s nice to have some explanation. Then I discovered that my love for vampire books and TV shows about the occult classify me as anti social and schizoid and my faith in their DSM went out the window. I am beginning to think it really is a way to dismiss people who are different by saddling them with a label.

    • June 17, 2010 at 11:41 pm | #2

      I would never dismiss the mental health realities that people experience. The DSM, however, is not a suitable mechanism to make sense of those realities.

  2. Ania
    December 6, 2010 at 12:28 pm | #3

    just a correction on the reference – it is actually in the 2010 volume for the journal, not 2009

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