The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a giant book laying out categories and criteria for all the various mental disorders recognized by the American Psychological Association. Its first version (DSM-1) was published in 1952, having been created out of a great need to give the psych field some order in the wake of WWII. Ever since then, the DSM-bestowed paradigm of discrete categories and specific disorders has increasingly dominated mental health fields. Health insurance companies classify you by DSM number (and require a DSM-legitimate diagnosis for coverage), and research studies are designed around groups of patients who meet the criteria for the specific disorder at issue.
So, I was very interested but surprised to hear that the National Institute of Mental Health (NIMH) has recently announced that it’s “re-orienting its research away from DSM categories.” NIMH is the biggest funder of mental health research in the world, so it has the power to finally lead research practices away from this dubious book.
The DSM, now in its 5th revision, has kind of a checkered past. For instance, it classified homosexuality as a psychosexual disorder until 1986! Critics of the DSM claim that its categories are not sufficiently scientific, that they fail to distinguish between external factors that may be affecting a person and her internal state, and that disorders make it into the DSM (or are excluded) according to western cultural biases.
So it’s potentially beneficial in the long run that NIMH abandons the DSM, but the shift away from the DSM must happen slowly, or it could do more harm than good. Even though the DSM has its problems, to its credit it gives the impression that mental disorders are medically real and objectively identifiable. Without this (albeit flawed) anchor, people with mental health issues might find themselves facing an even steeper uphill battle in getting their insurance companies to cover treatment. Is there any way to talk about the generalities of mental health problems without expecting everyone to fit in neat little diagnostic boxes? Hopefully the NIMH’s future, non-DSM-bound investments will revolutionize the way we think about, study, and treat mental health disorders.