Challenging the "Extensive Development Process" of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders

By Kean, Brian | Ethical Human Psychology and Psychiatry, April 1, 2013 | Go to article overview
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Challenging the "Extensive Development Process" of the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders


Kean, Brian, Ethical Human Psychology and Psychiatry


It is evident, over the past 30 years, that there has been widespread promotion of the concept of a biological basis for psychiatric disorders and direct promotion on the belief by medical experts in media, texts, and public meetings. In developed countries, and in particular die United States, this has resulted in epidemic comparable increases in the percentage of the population that are diagnosed as having a psychiatric disorder.

The associated increases in drug-based treatments have resulted in financial benefits to pharmaceutical companies and medical experts. This relationship raises questions con- cerning the construction of knowledge, particularly in light of the claims promoting a proven biological/neurological basis for many psychiatric disorders that, at diis point, has not been clearly established in research (Healy, 2012; Whitaker, 2010).

The claims made in the biopsychiatric discourse are supported dirough reference to experts' opinions, scientific research studies, and reports in refereed journals. Linked to the research studies and journal articles are medical experts, many in esteemed positions in universities, whose power over the discourse is impenetrable even to practicing physicians, nurses, other health workers, education systems, teachers, parents, and the individuals diagnosed with a mental health disorder.

Understanding the context of the hegemonic medical model of psychiatry is critical given the rapid increases in the number of individuals diagnosed with psychiatric disor- ders. What is considered normal in a society varies over time and die definition of devi- ance can and does change in accordance with the values of a society. The increased use of psychiatric diagnoses raises questions concerning the forces in society that have led to die acceptance of, and increasing promotion of drug regimes for an ever-increasing number of psychiatric disorders, evident in each new edition of die American Psychiatric Association's (APA; 2011) Diagnostic and Statistical Manual of Mental Disorders (DSM). With die imminent release of the DSM-5 in 2013, diis issue of the journal has a focus on questioning aspects of the hegemonic psychiatric discourse.

Individual and community expectations of psychiatric medical intervention are that treatments will produce positive outcomes and result in improvements in die functioning of individuals diagnosed widi a mental health problem. However, negative consequences from pharmaceutical and biopsychiatric treatments are not new or uncommon phenomena. Iatrogenic outcomes resulting from adverse drug reactions have been well documented in medicine (illustrated by die devastating consequences of dialidomide) and in biopsychiatry (illustrated by the development of tardive dyskinesia in a significant percentage of patients as a result of long-term treatment with neuroleptic drugs; Lader, 1993).

This issue of the journal concludes with an In Memoriam to Thomas Szasz. Szasz was one of the first significant critics of biopsychiatry. Szasz's initial text The My[h of Mental Illness, first published in 1961, critiqued the biopsychiatric construct of mental illness and outlined the potentially flawed constructs of biopsychiatry. Szasz's critical commentary was underpinned by libertarian views. He was damning of the role of psychiatry because of its coercive nature, reflected by involuntary treatment programs. Szasz's analysis extended beyond the problems of coercion associated with psychiatric intervention, and condemned the very construct of mental illness and associated treatments (Szasz, 1976).

In Pharmacracy, published in 2001, Szasz refined his analysis, defining "pharmacracy" as a totalitarian regime of social control that uses drug therapy as the main regulating mecha- nism (Szasz, 2001). The agents of the regime are the health care professionals, principally psychiatrists, whose certifying role classifies, what Szasz perceived as, socially undesirable, unacceptable, or criminal behavior as diseases and results in die use of psychotropic drugs and other biopsychiatric interventions for treatment and solution.

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