Has the DSM-5 Become the New Chinese Restaurant Menu for Mental Disorders?
“…someday.., we will medicate the human experience right out of the human experience.”
- Dennis Lehane
The diagnostic road of mental disorders has been, and continues to be, a lengthy, complex, and thorny one. Nevertheless, the Diagnostic and Statistical Manual for Mental Disorders (DSM) is arguably considered the bible of mental disorders. With its first edition, published in 1930, the DSM has become the go-to for the diagnosis and treatment of mental disorders. With its provision of diagnostic labels and codes, the clinical utility of each DSM edition cannot be ignored. The DSM has helped clinicians, insurance companies, medical aids, and researchers ease the communication of information on complex mental disorders. Unfortunately, utility does not mean validity (i.e., the ‘soundness’ or accuracy of a diagnosis).
The litany of criticisms that have been raised against the DSM diagnostic categories, particularly the categories for personality disorders, have been well-documented. Nevertheless, despite these shortcomings, these diagnostic codes and categories remain the point of departure for the treatment of mental disorders. Additionally, the use of diagnostic codes also forms a substantial portion of student psychologists’ and psychiatrists’ training. I would argue that student psychologists tend to leave their training institutions/practicums thinking that the primary aim is to diagnose. Even if this is not true for all entry-level psychologists, they often fall into this trap when forced by insurance companies and medical aids to provide a formal diagnostic code (i.e., ICD10 code), regardless of whether a suitable code/category exists.
Look, I cannot discount that these diagnostic codes do have their value, particularly when it comes to treatment considerations for serious mental disorders with a genetic and/or biological underpinning such as bipolar disorder, schizophrenia, temporal lobe epilepsy, and drug-induced psychosis, and other organic brain disorders. However, these diagnostic codes can potentially be counterproductive, even harmful, when used to treat less severe, everyday psychological impairments such as interpersonal difficulties, emotional dysregulation, existential anxiety, or distractibility.
Using the DSM categories as if they are menu items that you can pick from hasserious negative implications. Firstly, once a label is provided to a client, both the client and the therapist may become overly attuned to those aspects of the therapy that hold true to the label whilst discarding aspects that do not fit the label.
Secondly, once a client is given a diagnostic code, they tend to see themselves as having a “valid disorder” and may start to act accordingly — there is truth in the saying that you become that which you believe yourself to be.
Thirdly, clients often use a diagnostic label to absolve themselves of personal accountability. Instead, people seek validation for their struggles through a formal diagnosis rather than pursuing effective coping strategies and personal growth. As such, often clients fail to do the work required to work through their difficulties because they use the diagnostic label as an excuse. It is like getting a “You tried!” sticker, instead of actually trying. This directly hampers people’s resilience and self-efficacy, as they start to view themselves primarily through the lens of their diagnosis rather than their potential for overcoming challenges. This is not to say that all diagnoses are invalid and used as excuses. In fact, having an accurate diagnosis can be life-changing and life-saving!
Fourthly, the willy-nilly use of DSM categories dilutes the seriousness and severity of genuine mental disorders. When diagnostic labels are handed out like participation trophies at a kids’ soccer game, the gravity of conditions like bipolar disorder, schizophrenia, and severe depression gets overshadowed. This not only trivialises the experiences of those with profound mental health challenges but also turns the whole diagnostic process into a bit of a joke. Seriously, if everyone and their neighbour has a DSM label, what’s next? Diagnosing your moody cat with feline borderline personality disorder?
It’s essential to understand the broader implications of such misapplication. Overuse of diagnostic labels can lead to societal desensitisation towards mental health issues, where the line between normal emotional responses and pathological conditions becomes blurrier than a politician’s promise. This desensitisation reduces empathy and support for those with severe mental illnesses, as the sheer number of labels makes it harder to distinguish between serious vs manageable. It can also strain mental health resources, as individuals with everyday stress might end up occupying services that should be prioritised for those in genuine crisis.
Finally, by attributing every tough human experience to a little diagnostic box, we are pretty much eliminating the very essence of what it means to be human — complex! Struggling to cope after a loved one dies? That’s called mourning and grief, not major depressive disorder. Feeling overwhelmed and anxious about work because your boss thinks you’re superhuman? Normal. The abnormal part is the ridiculous workload, not your anxiety levels. It’s like trying to label a rainy day as a weather disorder. Of course there are cases in which it is not a “normal” human experience, and in those cases, a diagnosis is needed. Nevertheless, I do believe greater consideration should be given before a formal diagnosis is made.
I say all this because I feel that being diagnosed with some mental disorder is almost becoming a “thing”. For example, when someone shows a few characteristics associated with autism, then all of a sudden, they are on the spectrum. Similarly, instead of working to improve their social anxiety, people might prefer to label themselves as “neurodivergent,” accepting their lack of social skills as just part of who they are. This rush to diagnose tends to overshadow the personal accountability in working through difficult experiences.
In addition to the above, the overdiagnosis of mental disorders can distort our understanding of the true prevalence of these conditions, thereby generating misinformation that can have far-reaching consequences. For instance, data obtained from medical aids are crucial for guiding social policies and interventions, such as allocating mental health resources, planning public health strategies, and developing educational programs. Inaccurate data can lead to misdirected funding, ineffective policy decisions, and insufficient support for those who genuinely need it. When the data is flawed, it undermines any efforts to address mental health issues accurately and effectively.
Ultimately, the path of diagnosing mental disorders remains fraught with challenges, steeped in complexity, and often painful for those navigating it. Despite the indispensable role of the DSM in providing a structured framework for understanding and treating mental disorders, we must acknowledge its limitations and the potential harm it can cause when misapplied. The reduction of human suffering to mere codes and labels risks oversimplifying the rich, multifaceted nature of what it means to be human. I believe psychologists and psychiatrists must tread carefully when providing diagnoses by having a more discerning approach to mental health diagnosis that respects the profound impact these labels can have on a person’s life. By doing so, we as psychologists and psychiatrists, affirm our commitment to honouring the complexity and individuality of each person. And maybe, just maybe, we can keep people’s cats out of the chair!
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