Even though it often lies unused, the Diagnostic and Statistical Manual of Mental Disorders (DSM) remains the most influential book in medicine.
The DSM defines mental illness, not just for psychiatrists but for policy makers. Over the last decades, as policy makers have sought to give mental health parity with physical health, the fourth edition of the DSM, DSM IV, has been seen as the manual to what ails the mind.
So the evolving rewrite of this book, the DSM V, due to be complete by 2015, is not just a medical document. It’s a political document. As is now becoming clear.
Take my own family. I have ADHD. It’s a “spectrum disorder,” in that you can have a mild case, a severe case, or something in between. Mine is fairly severe, and the condition is inherited.
At the top of the ADHD spectrum is Asperger’s Syndrome. Asperger’s is also at the bottom of the autism spectrum — it’s a high-functioning autism.
What the authors of the DSM V have apparently decided to do is get rid of the distinction, and diagnose autism when they see symptoms of Asperger’s.
Symptoms like difficulty making friends, an inflexible adherence to routines or rituals, and a lack of social reciprocity, these are supposed to distinguish ADHD from autism. They don’t.
There is a big difference between Albert Einstein, who reportedly had Asperger’s, and the character played by Dustin Hoffman in Rainman, who was clearly autistic. This is not just a difference in social stigma. It’s a real, major difference in behavior, and a huge difference in what we do about the patient.
I know this from personal experience. Kids diagnosed with Asperger’s are already lumped by schools into a class of “disabled.” They are given extra time they often don’t need to take tests. They are treated as stupid when their problems are social and emotional.
This only gets worse when the DSM V moves from a tool of psychiatric diagnosis to a public policy document. We don’t have these problems with physical ailments. Doctors track manuals of physical diagnosis religiously, and treat patients as whole, only with a limiting disease process.
Not so with psychiatry. Psychiatrists often don’t use the manual, often do just what they want to do (rather than what science tells them to do), and public policy treats patients of all kinds as truly disabled.
While the science of the heart, or of cancer, is of the 21st century, psychiatry remains mired in the 19th, not only in the rejection of science by those sworn to treat mental problems, but in the isolation of sufferers — especially the young — by policy makers.
Every mind is different, unique, one of a kind. This does not mean they are unknowable, or that treating them is an art or a branch of voodoo. But it also makes labels harder to place and harder to bear.
As I discover anew every day.
