Maintaining our health is one of the most important things we can do, both as individuals and as a society. To do so, most of us rely on the health system around us, made up of nurses, doctors and pharmacies. We hope – and, perhaps too often, assume – that those that make up this system are objective and have our best interest in mind.
But is our collective trust in health professionals misplaced?
It is this public trust that makes what is occurring with the DSM-V so terrible.
The Diagnostic and Statistical Manual of Mental Disorders, better known as DSM, is published by the American Psychiatric Association (APA) and is widely used as a source for the criteria for diagnosing mental disorders. The first edition was published in 1952; the most recent version, DSM-IV, was last revised in 2000. The APA has been working on the next update, DSM-V, for years.
There are a number of changes in the pipeline for DSM, some of which are incredibly controversial. It is not these shifting criteria, however, with which I have a problem. Rather, it is the method through which the DSM-V is being fully compiled.
In the more than four years in which the APA has been drafting DSM-V, most of the process has been closed off from the public and interested parties. Members of the DSM-V task force, charged with developing the new guide, had to sign non-disclosure agreements. More unsettling is the fact that 70 percent of those tasked with developing DSM-V have industry connections.
The DSM-V development process reeks of back room deals. While the APA and the task force deny any wrong doing, there was never any need for the lack of transparency.
On the surface, these all seem rather innocuous. But even a small diagnostic change could have rippling effects throughout our mental health system, and even the greater health system.
For instance, one of the proposed changes will classify the grief following the death of a loved one as a symptom of depression. Is this really depression, or is it just mourning? Or is it an attempt to secure the ability to sell more anti-depressants to the American public? These kinds of questions continually pop up while reading through the proposed changes.
And, despite what many may think, these changes affect everyone. Even an apparently minor change in diagnostic criteria can spur the need for a new drug or could limit the help in-need individuals can receive. It can only seem that the public trust – that need for objectivity and empathy – is missing.
What’s more disturbing is the ever-growing role of money in medicine.
I understand it’s always been important, but with pharmaceutical advertisements constantly pervading and peppering our lives, who’s really making the health decisions? Are doctors treating us when we go in and ask for the newest little pill because we diagnosed ourselves based on a minute-long commercial? I don’t mean to vilify doctors in any respect, as I know they are more pressed for time than ever. But something has to be done to curtail the influence of spending on things as important as our health.
The DSM-V will likely be released in May of 2013. Regardless of the process that went into its development, its release will forever shake and shift our mental health system. But this is just a representative of what seems to be quickly becoming the norm: big bucks pushing medicine we never needed with disorders we never had.