We're All Crazy: The Uses and Abuses of Psychiatric Diagnoses

(3 minute read)

When I was in graduate school I was handed a copy of the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual (DSM), the book that is considered the ‘bible’ of modern day psychiatry, and told that half of all Americans will qualify for a psychiatric disorder at some point in their lives.

In other words, half of us are crazy.

Sorry, APA, but that’s just crazy. If half of us are abnormal, what does it mean to be normal anymore?

It’s not just outsiders who think something is wrong: The Chairman of the previous edition of the DSM wrote a book on this subject called “Saving Normal” and the doctor who is widely seen a the Father of Attention Deficit Hyperactivity Disorder (ADHD) also publicly regretted how the diagnosis has spun wildly out of control. Even the great and the good of psychiatry are questioning what happened to ‘normal’.

If you want a layman’s view of the problem, try the myriads of online self diagnostic ‘tools’. At Psych Central, a popular source of information, you can check if you have depression, ADHD, Anxiety, Autism, Bipolar, Binge Eating, Eating Disorder, Grief, Hoarding, PTSD, Schizophrenia, Borderline Personality Disorder, and whether you’re Paranoid, Narcissistic, Sexually Addicted or at risk of suicide. They’ll also tell you if you’re a psychopath. And just for good measure, they’ll let you know if you’re being Drained By an Energy Vampire. (Seriously.)

There are some people for whom a diagnosis comes as a relief. Knowing that you are not alone, that other people suffer in the same way you do, can be very comforting. (If you’ve been diagnosed, and you feel good about it, stop reading this now.) But for many people, it’s a label: they’re no longer the person they used to be, and instead have become their ‘disease’.

And how exactly, does the helping profession know that we have a ‘disease’? Since there’s no blood test, MRI scan or anything else that will show we’ve got one, the only way that anyone can tell if someone has a disorder is by observing their behavior and asking them how they feel. And then judge them against the criteria in the DSM, that bible of psychiatry. If you meet enough of the symptoms in the DSM — bingo! you’re slapped with the label of Major Depression, or Panic Disorder, or Schizophrenia or whatever.

You might well ask — what’s wrong with that? After all, those DSM symptoms must have a good reason for being in the DSM. The American Psychiatric Association wouldn’t publish anything that doesn’t make sense would it? To answer that question you need to understand how those psychiatrists decide on what is a disorder and what symptoms a person has to show in order to qualify for it. Here’s a simplified version:

1. A “Task Force” of psychiatrists talk for a long time and then have a vote to decide whether a set of thoughts, behaviors and feelings is a disorder.

2. The psychiatrists then go out and find a bunch of patients they think have the thoughts, behaviors and feelings.

3. The psychiatrists then interview the patients and the people around them to see what thoughts, feelings and behaviors the patients have.

4. The psychiatrists then vote on which and how many of those thoughts, feelings and behaviors need to show up in a person to qualify them as having that disorder.

5. Whatever the psychiatrists have voted on gets put into the DSM.

As you can see, this is not a scientific process — it is a very human and political process. What gets defined as a disorder depends on the judgement of a group of doctors at a certain point in history. How human and political is the process? Well, until 1974, according to the DSM, if you were homosexual, you had a psychiatric disorder.

You may think that’s ancient history, and that kind of nonsense wouldn’t happen today. It does happen today. In the 1990’s the APA decided that Bipolar Disorder didn’t just affect adults, that children could have it too. As a result, diagnoses of kids with this disorder rose 4,000% in the nine years up until 2003, and probably much more after that. They were put on heavy antipsychotics, drugs that can significantly shorten the lifespan of an adult, let alone a child. The drugs were ineffective to boot. And then in 2013 the APA voted that they’d made a mistake and renamed Childhood Bipolar as Disruptive Mood Dysregulation Disorder, for which there is no medication. But in the meantime an awful lot of kids were given terrible drugs for their ‘bipolar disorder’ that shortened their lives and did nothing to help — all based on the votes of these psychiatrists.

Attention Deficit Disorder is another diagnosis that has been highly politicized. Originally called “Minimal Brain Damage” and seen as very rare and disappearing by the age of 12, by 2011 some 11% of the children in the USA were being diagnosed. Diagnosis rates are continuing to rise rapidly and the disorder is making significant inroads among adults too. Among the 18 criteria used in diagnosing, the word “often” is used 17 times, leaving plenty of room for enthusiastic doctors to over diagnose their patients. Does “often” mean once a day, once a week or ten times a day? You (or your doctor) get to choose.

So if you’ve been told you have Depression, or Generalized Anxiety Disorder, or ADHD, or any of the other hundreds of potential diagnoses, take it with a grain of salt. The experts who have diagnosed you are probably just whistling in the dark.