Diagnostic and Statistical Manual of Mental Disorders

Introduction

Mental health has been a critical issue of discussion in regards to the use of classification systems. Classification has enabled the diagnosis of psychiatric disorders to allow creation of theories that can treat mental health patients. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has compiled expert opinion on handling various categories of illnesses. However, criticism against classification and the DSM argues that they are not beneficial in improving psychiatric help. The DSM has allowed misdiagnosis of symptoms by using wide criteria that identifies usual emotional reactions as an illness. It has also received attention due to the effects of labeling patients which leads to social stigma and low self-esteem. The diagnostic manual also suffers the limitation of reliability and validity. Some of the descriptions of illnesses such as bipolar disorder and post-traumatic disorders do not conform to the results of studies done on the ailments. Classification is also portrayed to be manipulated for financial benefit by researchers that are associated with pharmaceutical agencies. Hence, diagnosis focuses on selling medical treatment that can lead to addiction rather than appropriate treatment. The paper will argue that classification through the Diagnostic and Statistical Manual of Mental Disorders does not benefit mental health because of misdiagnosis, labeling and stigmatization, lack of reliability and validity, focus on economic and personal interests and cultural differences.

Body

Classification in psychiatry has been used to categorize and evaluate mental illnesses. Its earliest use is applied Hippocrates, who identified the different categories of psychological problems based on physical imbalance of certain nutrients. Classification involves labeling a group of symptoms and prescribing the best type of treatment for the particular condition. One of the systems of classification is the Diagnostic and Statistical Manual. The DSM is a collection of multiple disorders and is compiled by the American Psychiatric Association (Vahia, 2013). It contains descriptions of mental sicknesses and the type of traits exhibited by patients. Hence, it is a guide book for psychiatrists and undergoes regular updates over a period of time.

Arguments against classification systems

The diagnostic criteria are not beneficial to psychiatric health because it enables misdiagnosis of illnesses. Patients are likely to be diagnosed with the wrong disorder because of the broad range of shared symptoms. For instance, patients that share only certain symptoms can be diagnosed with the same condition (Khoury, Langer & Pagnini, 2014). According to Khoury, Langer and Pagnini (2014), individuals that show varying traits associated with major depressive disorder are still labeled under the same category. It means that people can become placed under wrong treatments without their knowledge. Patients are dependent upon the advice and knowledge of medical practitioners as it is critical to their wellbeing. The DSM’s lack of clarity in regards to separating disorders can place one on medication that is unsuitable for their condition. In regards to major depressive disorder, a patient experiencing fatigue or feelings of worthlessness will be categorized under the illness even though they are facing a different problem (Khoury, Langer & Pagnini). Provision of medication to the individual could have long-lasting negative effects that debilitate their life. Psychiatric drugs are known to have reactive effects especially for those that are inaccurately diagnosed. Misdiagnosis is problematic to effective treatment because it can affect a vast population of potential patients. According to Rief (2014), 50 percent of people living in the United States will undergo psychiatric evaluation. It demonstrates that the number of misdiagnosed cases will increase over the years. There will be a higher quantity of patients that experience regular treatment procedures that are not useful to their wellbeing. It reduces the effectiveness of using classification systems and the public’s trust in it. Over time, psychiatric treatments may be perceived as faulty thus affecting the quality of managing psychiatric disorders. Therefore, the inaccurate classification of disorders makes it problematic for mental wellbeing.

Moreover, classification causes labeling and stigmatization of patients which affects their social life. The labels applied by the DSM to categorize disorders create a negative identity for patients. Although labels are used for the purpose of easier clarification by medical professionals, it creates a problematic automatic assumption amongst the general population (Rubin, 2018). People develop a negative perspective about affective disorders and those within the category. As a result, it causes public stigma and poor treatment within the social sphere. For instance, the label associated with schizophrenia may deny acceptance into the society. Family members or close friends may perceive a patient as an impending threat to their livelihood due to violent traits and difficulty in differentiating reality with hallucinations. It denies victims job opportunities and means of earning a livelihood due to psychiatric labels. Social circles become smaller, thus leaving an individual with a limited source of support. Lack of support can be detrimental for those that need physical and emotional motivation to complete their treatment. Labels perpetuated by the DSM are destructive as it can also cause self-stigma. Research states that psychiatric identities reduce self-esteem due to the stigma underwent from social circles (Rubin, pg. 98). It means that one believes the notion of incapability and avoidance of pursuing personal goals. The symptoms associated with an affective disorder are perceived as evidence that one cannot be functional in a public setting. Self-loathing can occur which can instigate harmful coping methods such as self-harm and mutilation. Stigmatization also encourages label avoidance which occurs by evading the visitation of mental health centers. Patients may avoid receiving harsh public treatment by hiding their procedures from close personnel. In the long-term, it can have adverse health effects due to lack of medical attention from physicians. Appropriate treatment and therapy will be missing thus worsening one’s symptoms and ability to resume to a functional lifestyle. Therefore, classification is not helpful for mental health because it promotes labels that lead to stigmatization.

Furthermore, classification systems are questionable within psychiatric care due to low reliability and validity. The DSM is criticized for lacking a consistent method of providing accurate diagnosis amongst medical practitioners (Jablensky, 2016). Patients can receive contrasting verdicts amongst varying physicians regardless of applying the same diagnostic manual. It showcases that the classification process does not enable a reliable testing method across a large population. The DSM is supposed to ensure consistent evaluation procedures that do not allow misinterpretation between mental health professionals. It can also cause confusion for the patient due to their dependence on professional advice before making a decisive action on their psychiatric status. A person that has contradicting information cannot effectively mediate their medical problem. The DSM enables medical personnel without psychiatric training to provide medical prescriptions with minimal assessment of the patient (Rief, pg. 281). Clinicians are only afforded a limited amount with an individual before providing drug recommendations. It is problematic to mental health because the doctor has not performed substantial analysis on whether the drugs are suitable for their condition. Also, the minor interaction between patients and prescription providers does not facilitate discussions that confirm the legitimacy of one’s diagnosis. The DSM seems to lack a streamlined process that can ascertain patients of validity in their psychiatric reports. The criteria used by the DSM lacks consistency in definition of disorders as categories have become too broad. Grief is considered a form major depressive disorder although it is a normal human emotion (Rief, pg. 281). Thus, usual human reactions are being accounted as psychiatric problems that require pharmacological treatment. It inhibits the focus on actual cognitive issues that require immediate intervention. The lack of efficient standardization may create health scares for symptoms that can be healthy phases of trauma such as grief. Hence, the DSM’s lack of reliable standards makes it ineffective in supporting psychiatric wellbeing.

Also, criteria of the DSM are biased due to the existence of economic interests from psychiatric experts. The diagnostic manual has become a source of financial revenue due to the influence of third party companies and pharmaceutical organizations (Cosgrove et al., 2014). Medical drug companies acquire substantial revenue from the sales of antidepressants and antipsychotic medication. An enlarging market is their main priority as compared to ensuring effective treatment. Mental health researchers responsible for improving the DSM have financial ties to drug companies. It means that diagnosis of illness will be biased and meant to promote their profitable investments within pharmaceutical sectors. It is problematic for mental health as descriptions in the DSM will support the use of pharmacological treatment rather than therapy. Hence, current classification systems are not based on empirical clinical tests but subjective attempts to encourage the use of antidepressants. Medical diagnosis is expected to be free from personal bias as the patient is the most significant subject. Financial ties negatively affect the aim of psychiatric health which is to suggest factual diagnosis to an individual that allows fast recovery. Instead, panel members that are responsible for the diagnostic criteria concentrate on acquisition of wealth through the patient’s misery. The role of pharmaceutical organizations in the creation of the DSM promotes the expansion of its diagnostic criteria. Companies can fund for clinical trials that suggest patients that portray certain extreme traits to be legible for their medication. It leads to poor revision and diagnosis of disorders in the diagnostic manual, making it unappealing in tackling psychiatric conditions. Such antics can heighten the existence of drug addiction within the mental health community. Psychiatric intervention can become based on antidepressants even amongst young consumers, contributing to an addiction problem within the United States. As result, financial bias amongst researchers makes the DSM classification non-beneficial.

The classification system of the diagnostic manual does not consider cultural differences during diagnosis. The criteria used to evaluate mental disorders are based on a Western perspective and its definition of normal rather than a universal one (Shorter, 2015). It is problematic to mental health because normal is subjective and cannot be defined. Empirical studies cannot truly the difference between usual and pathological conditions. It means that people are psychiatrically labeled based on subjective concepts and the society’s expectations of a normal personality. Also, different cultures have varying notions of normality which are supposed to be included in the DSM criteria. Individuals that are considered pathological by Western experts may not treated them same in their society. It may create an unfair judgment as patients that would lead ordinary lives would be placed in psychiatric care due to a Western definition of common human behavior. It negatively affects mental health treatment as immigrants are forced to conform to a contrasting culture to fit into its cultural barriers of normality. Psychiatric definitions that are defined by a culture are problematic as values evolve over time. It means that classification systems are not based on scientific fact but dependent on cultural progress. For instance, homosexuality was named as a mental problem in the DSM before progressive ideals occurred in the United States (Khoury, Langer & Pagnini). Hence, those that would have been placed under pharmacological treatment would have taken medication for a condition that is not a psychological disorder. The DSM is problematic for mental treatment because it cannot be effectively applied in a non-Western context. Clients would risk receiving inaccurate diagnosis thus making it a limited tool. Therefore, the Western nature of DSM diagnosis makes it an ineffective mental health instrument for non-Western patients.

Conclusion

The classification system applied by the DSM is not helpful for mental health due to poor diagnosis, labeling, unreliable, personal interest and its Westernized cultural system. Patients are liable to receiving wrong diagnosis because of comorbidity. The negative label placed on clients reduces their social opportunities while discouraging them from pursuing treatment. The DSM criteria lack reliability and validity as people can receive different diagnosis when attended to by a various doctors. Psychiatric researchers associated with the revision of the manual are influenced by financial associations with medical drug companies. Also, clients are evaluated by Western ideals rather than universal ones. The argument is significant as it encourages the improvement of diagnosis. A lot of people require psychiatric assistance, which necessitates the existence of an accurate diagnostic and statistical manual.

References

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