Next year the American Psychiatric Association will release the latest edition of the Diagnostic and Statistical Manual of Mental Disorders, the bible of psychiatric diagnosis. The DSM 5, as it is to be known, has created an unprecedented amount ofdebate and controversy. And for the first time in the manual’s history, the debate over what to include and what to discard has been played out on the internet. Psychiatrists, public health advocates and consumers have all entered into the fray. Two of the most vocal critics of the new edition, Allen Frances and Robert Spitzer, have both been part of committees that have produced former editions. At stake is not only how we speak about and diagnose mental health problems, but also who receives government assistance. For the first time we’re talking widely about how we classify mental ill health. And for many of us, the question that grabs our attention the most is what the limits of normal really are.
Late one night a few years ago, a friend rang up with a revelation about her then husband. “He’s got an Obsessive-Compulsive Personality Disorder! He meets all the criteria.” She was relieved and felt supported because someone out there had taken the time to describe what she was experiencing. The DSM IV had given her a language and a framework to make sense of her mate’s behaviour. He wasn’t simply more interested in folding towels than talking to her. She was no longer alone with a seemingly random set of observations. She had words.
We need to find part of ourselves in the outside world. If I can’t “language” myself, I can’t experience myself. This is the true joy of diagnosis. In the case of our experience of other people, diagnostic frameworks for so-called abnormal behaviour offer us support for our feelings — it’s not just me, someone else can confirm my experience. They give us a kind of expert back up for our relational puzzles.
Diagnostic labels entered the realm of interpersonal communication with the advent of psychoanalysis and we still incessantly diagnose behaviours in regular conversation. Our bosses are sociopaths; our friends are in denial, depressed or passive aggressive; our mothers are narcissistic. These labels can be useful catch-all containers for complex and painful events. Other people know what we mean, and we have some psychiatric backing for our discontent.
But with each diagnosis, lay or professional, we reinforce an idea of normality. With each label we are defining and reinforcing the notion of what normal is or should be. We do this mostly for ourselves. To understand our own reactions and to understand our place in the psychological world. We want to know what the limits of normal are and we want to know that we fall within them.
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