Winding up a fourteen-year process, the new Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), was released earlier this year. Originally billed as rolling out a new psychiatric paradigm, the chaotic and secretive project ended up being rushed to print without field testing.1 The nondisclosure agreement that contributors were required to sign was publicly criticized by the chair of the DSM-III task force.2 Though the new manual was welcomed by some as another step in catching people who have been falling through the cracks, the overwhelming response was negative.
The DSM, which classifies hundreds of mental disorders, is the bible of psychiatry. Insurance companies rely on its detailed codes to determine reimbursement, and it influences the way doctors prescribe drugs.
DSM-5 added ten new mental illness diagnoses and loosened the criteria for many others. Allen Frances, M.D., chair of the DSM-IV task force, denounced many of the changes as seeming "clearly unsafe and scientifically unsound," and asserted that blind adherence to the new criteria would lead to "massive over-diagnosis and harmful over-medication."3 Current odds are that, based on the DSM-5, half the population will have a diagnosable disorder in their lifetime.
A few examples illustrate the appropriateness of Dr. Frances's concerns: Per the DSM-5, recurring overindulgence is now Binge Eating Disorder. Children with temper tantrums suffer from Disruptive Mood Dysregulation Disorder. There's a diagnosis for a specific obsessive-compulsive behavior called Hoarding Disorder, and another (my personal favorite) for Caffeine Withdrawal. Being grumpy in the morning until I sip my Nespresso coffee isn't a character issue for me anymore; it's a mental problem. At the other extreme, of course, is Caffeine Intoxication.
This pattern portends two disturbing trends. One is toward the homogenization of the human personality by narrowing the range of what is considered normal. People who are anxious under stress, collapse in a crisis, or get despondent with grief—all common reactions—may now be regarded as abnormal. A diagnosis can lead to judging, labeling, and stigmatizing a person. Or it can lead the diagnosed person to seek personality-altering drugs so he can fit in.
In the "new normal," what will be lost? Perhaps the spectacular human diversity that builds civilizations and cultures. The great figures of history were not well-behaved schoolchildren. Most great artists were not cheerful, compliant extroverts. And great discoveries were not made by mild-mannered, complacent researchers.
The second trend—toward medicalization—results when more and more aspects of human experience and behavior are seen as problems to be solved by medicine. The emotions elicited by the normal challenges of life, such as grief, sadness, depression, and irritability, are pathologized, treated as a disease to be cured, not a character-forming occasion. The root of the problem is a shift in our understanding of the boundaries of normality, health, and human flourishing.
At its 20th annual conference held earlier this year, the Center for Bioethics and Human Dignity addressed "Health and Human Flourishing." Speakers expressed the concern that medicine and technology have veered from repairing injury and curing disease to expanding human capacities and "correcting" the effects of normal human experience. Dr. Allen Verhey cited our cult of health, where "hospitals and exercise facilities are the temples, and doctors and dieticians are the priests."
Christians recognize that health is a good thing, but it is not the greatest good. Rather, Dr. Verhey said, it is in responding to God's grace and goodness with doxological gratitude, in remaining joyfully hopeful about our future, knowing that the Spirit is drawing all things toward God's good ends, and in loving both God and neighbor, that we realize true human flourishing. •
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