January 31, 2012
The DSM-5 controversy continues, as more professionals and parents share their experiences and opinions regarding specific diagnostic changes and their impact on people’s lives. This is happening on the blogospere and in major media like The New York Times, which in the last ten days has had front page articles, op eds and letters on depression and ADHD and autism.
The debate goes something like this: Fewer kids will get services if …; Medication is fine, but it’s not everything; But medication was a lifesaver for my kid; Is grieving a sign of depression? Always? If the criteria around grieving changes more people will be diagnosed with depression…and so on.
Lives are at stake, Long-term, no one knows the effects of the drugs that almost inevitably follow a diagnosis of, say, ADHD in a child. Short-term, parents and teachers want something to minimize the chaos they experience, whether that be a drug or special services their children become eligible for with a diagnosis. These are critically important practical policy issues.
But none of this has anything to do with science. The DSM-5 is not a scientific document. To portray it as one is a gigantic hoax. The debate that psychiatrists are having about this and that category of mental disorder is as scientific as a debate about how to classify the different languages spoken by aliens from space. They’re arguing about the very things they themselves made up! They’re debating the virtues of their map but they’re telling us they’re talking about our territory. Have they forgotten that what makes a map a map is the gap between it and the territory? Or are they deliberately disseminating misinformation to the public? Either way, it’s unethical (and takes a lot of chutzpah!).
Some of the experts now speaking say that the science has to get better, that we don’t yet know enough about the brain and biology. They’re just perpetuating the hoax. I’m all for discovering as much as we can about the brain. The men and women working in neuroscience are probably really good scientists—because their research doesn’t violate the brain. The brain is an organ and, from what I’ve read, it’s being studied in ways consistent with what an organ is.
But a person who doesn’t get out of bed? A 6 year-old boy who doesn’t sit still 6 hours a day? A 14 year-old girl who pulls her hair out? Each one of them has a brain, but they are not their brain. Their behavior, their emotional and relational lives, and their pain and distress are social, cultural activities that exist in the world. Relating to them as anything other than this is unscientific.
The notion of science I’m invoking is that it’s an exploratory enterprise that doesn’t violate the integrity of the thing being explored. Diagnosing “mental disorders” in human beings is both a scientific and a moral violation.
So let’s have some honesty in the DSM-5 debate. When it comes to emotional pain, science-talk doesn’t cure. But it does procure.