This weekend, there’s going to be an Occupy day of protest and rallies in Philadelphia—but not by Occupy Philly. On Saturday, activists will come from all over the country for Occupy the APA, a peaceful day of action to protest the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which is being rolled out at the annual meeting of the American Psychiatric Association (APA) at the Convention Center. Unlike other protests that sometimes divide the mental health advocacy community, this protest will include people from diverse constituencies—from psychiatrists and those who take medications to psychiatric “survivors” who believe psychiatry is dangerously abusive.
The DSM, as it’s familiarly known, is often called the bible of mental illness because it’s how, for all intents and purposes, a person’s constellation of symptoms is solidified into a firm diagnosis, a billable diagnosis code, and an acceptable FDA-approved category for certain pharmaceuticals. The DSM has always been controversial; it classified homosexuality as a mental disease until 1974. And many psychiatrists confess to frustration when they’re forced to pick a diagnosis for patients whose mix of complaints is too vague to identify.
The DSM has the power to change perception. It can give and take away. For instance, the new DSM refines the criteria for Premenstrual Dysmorphic Disorder (PMDD), a severe form of PMS. Proponents argue that insurance companies will pay for more treatment options now that the DSM has given PMDD its blessing. Opponents say PMDD shouldn’t be in there to begin with because it stigmatizes normal female physiology. These are the kinds of arguments that bedevil the manual all the time.
The stakes are particularly high with children, whose bodies and brains are still developing when they’re prescribed drugs made for adults. In the last few years, there was an explosion of childhood bipolar diagnosis. It’s now generally acknowledged that scores of those diagnoses were incorrect, and that many children were medicated unnecessarily. Part of the blame has gone to pharmaceutical companies, for obvious reasons. But prescriptions were written based on criteria in the DSM-IV, which is why the DSM-V refines the criteria for childhood bipolar disorder. While the new definition may be a step forward, the culture of the DSM and its inclination to classify behavior is at the root of the problem. Some children are just … children.
The DSM encourages an obsession with diagnosis rather than a respect for what’s happening with a person at that time in their life. I know many people who have been diagnosed with major mental illness and put on medication after a 15-minute session with a psychiatrist they’d never met previously. How is that possible? Because they meet the DSM criteria. But barring frank displays of severe psychotic symptoms that require medication (and I say this as a person who takes meds for such symptoms), such a diagnosis can’t have much to do with what a person really needs. My own doctor often chides me for focusing on my diagnosis. “Just tell me what’s going on,” he says, “and let’s see if we can’t help.” Sometimes that help involves medication. But sometimes it involves talking. The diagnostic criteria for bipolar disorder in the DSM? They don’t come into play.
David Oaks, who runs MindFreedom International—which, among other things, rescues people who are being given shock treatments involuntarily—will be here this weekend from Oregon. In a public statement, he said the DSM pushes doctors to “medicalize problems that aren’t medical, inevitably leading to over-prescription of psychiatric drugs—including for people experiencing natural human emotions, such as grief and shyness.”
Another longtime advocate, Jim Gottstein, will be here from Alaska. He has an especial concern with the way the public health system uses the DSM. I’ve been a part of that system here in Philly, and it’s very depressing to see how people have been encouraged to equate themselves with their diagnoses, assuming they’re consigned to a life as “A Schizophrenic,” with capital letters. It gets reiterated for them at each engagement with the system, when the first question they’re asked is, “What’s your diagnosis?” It’s dehumanizing.
Before I worked in that system, and before I met a psychiatrist who encouraged me to focus not on the diagnosis, but on my thoughts and feelings, I wouldn’t have given much thought to this protest. But it has become fairly clear to me that in most instances the DSM is not, in fact, facilitating wellness. And I’m not sure most psychiatrists even buy it anymore. But there are alternatives, and that’s what Occupy the APA advocates: a new perspective. Speakers will present alternatives at the Friends Center at 15th and Cherry starting at 10 a.m. on Saturday.