Still More on the DSM Discussion

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From the 14th edition of Abnormal Psychology by James N. Butcher, Susan Mineka, and Jill M. Hooley (Boston: Allyn and Bacon):

“The concept of mental disorder, as we have seen, suffers from the lack of a truly objective means of what is disordered and what is not. It is also in the financial interests of mental health professionals to be more and more inclusive of the kinds of problems that might be regarded as ‘mentally disordered.’ Not surprisingly, there is often more pressure to include in the DSM more and more kinds of socially undesirable behavior. One proposal was the inclusion in DSM IV of road rage (anger at other drivers) as a newly discovered mental disorder. However, anger directed at other drivers is so common that almost all of us would be at risk of being diagnosed with this new disorder if it had been added to the DSM.

“There is considerable informal evidence that the committee responsible for the production of the DSM worked hard to fend off a number of such frivolous proposals. They largely succeeded in avoiding additional diagnoses beyond those that appeared in the previous editions (DSM III R) by adopting stringent inclusion criteria. Nevertheless, this promises to be an uphill battle. Mental health professionals, like the members of other professions, tend to view the world through a lens that enhances the importance of phenomena related to their own expertise. Also, inclusion of a disorder in the DSM is a prerequisite for health insurers’ reimbursement of services rendered.

“It is thus in the interests of the public at large to keep a wary eye on proposed expansions of the ‘mentally disordered’ domain. It is conceivable that to do so might eventually lead to a situation in which the majority of the array of human behavior (save for the most bland, conformist, and conventional of conduct) would be declared a manifestation of a mental disorder. By that point, the concept of psychopathology would have become so indiscriminate as to lose most of its scientifically productive meaning.” (p. 26)

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