DSMV reviewed as a work of dystopian literature

There is no definitive list of what is a mental illness or not any more than there is a definitive list of what is a physical illness or not. It is based on clinician expertise. The DSM is designed so that if you use its diagnostic criteria you would get the same results as experts in the field would get with statistical significance. In the case of the **pre-**DSM-III, you would find a diagnostic criteria for homosexuality since it was accepted by clinicians at the time to be a mental disorder. This is the primary reason I am not happy with the DSM series, but I accept that there really isn’t much of an alternative. If you consider a mental illness a disability instead of a deviation from normality, you can narrow the field somewhat (since homosexuality does not impair your behavior or cause significant distress in and of itself). But there is always going to be some point where the doctor thinks it is an illness and wants diagnostic criteria so that research can be performed and compared with that of others as well as to determine the efficacy of different types of treatment.

And yes, I understand that lobbying is an issue with the DSM-5. I find this disturbing, but I have not seen any evidence that clinical trials were affected or that the diagnoses are scientifically incorrect. I hope that the NIMH concerns are addressed and a more accurate manual is created. Nonetheless, it does not invalidate it. It makes the DSM-5 an imperfect manual that may misdiagnose or underdiagnose more people than necessary (as are all diagnosis manuals). The APA really did not take the opportunity to maximize the accuracy of the DSM-5. This means the DSM-5 isn’t a great manual. But it doesn’t mean that it is wrong or that it can’t be used for scientific research or diagnosis.

Edit: Noted that homosexuality was actually removed in a printing of the DSM-II, not DSM-III. Here is a good podcast on how it happened:

Thanks for clarification. We seem to agree on everything except the quality of the review.

I’m glad to have an expert in this discussion.

As far as the textbook aspect, I never really felt that it worked that way. From my reading of it, it provides “basis documentation”. By this I mean that it provides information that is useful to a professional on what and why a particular disorder or classification is based (as well as the reasoning behind the manual itself). This isn’t a unique aspect of the DSM-IV-TR or DSM-5. Many fields do this now because the utilization of a manual or a procedure often requires detailed knowledge and experience of what professionals intend to be meant by the manual or procedure. For example “significant impairment”, what does that mean? The text supplement and basis documentation helps to clarify. And a student could certainly learn some information from this text, but I wouldn’t expect them to be able to use the actual diagnostic manual without professional training.

Most of this discussion belongs on the DSM v website rather than this page. The review was a snarky mind exercise that in itself, succeeds. It is not an analysis of the controversial publication, it is an outside the norm reworking of the critics. Enjoy it or not, I would suggest unless you are really ready to take on the actual current criticisms, get over it. Nothing here to see folks. I thought it was funny/scary/ brilliant.


Aren’t females more likely to engage in prostitution than males, period? And aren’t runaway/ homeless teens more likely to engage in prostitution than teens who live at home?

But yes, I have issues with CD/ ODD diagnoses in general; I think they’re highly overused in lieu of a deeper examination of what’s really going on. But hey, at least they’re trying to stop practitioners from diagnosing school-aged kids with bipolar disorder because they’re having meltdowns.

I love how your avatar matches your comment perfectly :^)

but advocating the destruction of an artwork, particularly a cherished cultural touchstone, is off-limits. that’s how we ended up with Han shooting second. no thanks. not even as a joke. just going to have to endure the pedants, lame as they may be.

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Very well observed in terms of form. Fairly inane in terms of content. There is indeed a long history of saying that anyone who disagrees with a particular position (generally what the government says) is ‘mad’ and therefore should be ignored and imprisoned. We should indeed be very cognisant of this, and mental health processes should be as transparent as possible. This doesn’t mean that no one has these problems or that helping people with these problems is an innately terrible thing.

As a commentary on why left-leaning people are annoyed by this, I would suggest that opposition to mental health provision is expected from the right. The faking/weak/useless narrative is fairly well established. The leftish ‘diagnosis is a tool of oppression’ feels like a betrayal.


Well said. I feel like this issue divides the left into two groups that I bet political anthropologists (or whatever the relevant field is) has names for, but which I don’t know. In my head it’s the science-oriented left and the humanities-oriented left.

The responses of bzishi and others here seem to me to be the epitome of whoosh.


Please tell me how a value judgment between a “normal” deviation and a “disorder” could ever be scientifically validated. Even in a physical illness, what separates a condition like cancer from a normal bodily function is our desire to stay alive. Or how typical it is, in the case of aging. (Please note that I’m not saying physical illness is desirable or “not that bad.”)

Yeah, no shit.

I love it! I’ll take your Inferno and I’ll raise you one THE BLACK INSIDER by Dambudzo Marechera.

I read this. It made me crazy.


I have a feeling that before too long this critique will be cited in court; as useful as mental health practitioners find the DSM, I think it’s a quite valid point that it has some less than desirable effects…

I think that’s what Asbrodean is getting at. It cannot be scientifically validated, therefore its scientific legitimacy is questionable.

The thing is, when someone rebuts that something is VALID, it’s already biasing the terms of argument.

A longstanding critique of the DSM is that the DSM does not simply describe and classify characteristics of groups of individuals, but actively invents a version of both normal and abnormal. It’s inherently a political judgement of how people are SUPPOSED to live by the people writing the book- and none of it is based on biological measurements.

But arguing something is VALID gives a false sense of neutrality and objectivity, and implies that there is something scientific about the the system with which the DSM is created.

There is no objective way to measure the things the DSM claims to objectively measure.

I’m a lame pedant. But only because I’ve broken my toe.

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Deconstructing psychiatry’s DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible

One criterion that’s used is that of impairment, that is, does this issue or set of issues cause the client pain, concern, worry, or doubt? Does it affect their work, play, sleep? Do others notice the impairment, and how are they affected by it? These aren’t scientifically provable so much as that they’re useful concepts that account for a lot of messy human data, and they seem to help people feel better. The DSM doesn’t claim the same scientific, objective rigor that the “hard” sciences do: it starts from a different place, talks about different things, and arrives at different conclusions, much of which are targeted at real people and their real problems. Joke reviewing it as a dystopian whatever or upbraiding it for not being “science” is missing the issue.


“Please tell me how a value judgment between a “normal” deviation and a “disorder” could ever be scientifically validated.”

You seem like someone making up words because you don’t understand the subject. “Normal” deviation? A deviation is a deviation is a deviation. It is the scientific word for “not normal”. Scientifically, a deviation means NOTHING. That is the scientific validation. Disorder? That is what requires human judgement. Are you impacted negatively by this deviation? Science isn’t going to answer this, the individual is in consultation with a professional.

For instance, I have the physical criteria for ADHD…Attention Deficit Hyperactive Disorder. In my case, its not a disorder. I have a deviation from the standard attention that most people do, and I fly off the walls trying to contain my energy, but I have a lifestyle where this is a positive, not a negative. However, this is where the DSM gets maligned…too many people that have no business using the book and have never been trained to use it are using it. School nurses in the US are diagnosing kids with ADHD without knowing what this means. In the US, you only have to have an undergrad degree to be a nurse. I am not going to say negative things about the field, but it is one that is more about memorization of symptoms and treatment than it is an understanding of disease causes. And this is needed. However, there is a reason more specialize folks are around. In the mental health field, one is NOT supposed to diagnose with just a Master’s degree. This is the realm of PhD and MD level persons. Over the years, Master’s Level Therapists have done so with he rubber stamp of someone above them, and are lobbying to have their own rubber stamp. And then you realize that the #1 diagnosis of ADHD in America comes from High School Nurses who don’t even have near the education of the Master’s Level Therapists that aren’t supposed to diagnose either.

The problem with reading the book is that at least the nurses had a 6 week course that went over the DSM. And then you realize that 99% of the people complaining about the DSM and psychiatry / psychology? They MIGHT have had a single 100 level course in college talking to them about the field and yet are now experts.

And that is the difference between “normal” deviation and “disorder”…training from someone that can discern if it is impacting ones life. Considering impacting ones life is a qualitative inferences, you will never have scientific validation that meets the criteria of the “hard” sciences. I wish that in this field I could bring out my old calc books, figure out a few formulas that have physics based constants and prove something is or isn’t, but that ain’t the field and it never will be.


Yes, that’s sort of in line with the criteria I’m familiar with. As someone who’s mentally ill, I find the whole “but it’s just a social acceptability thing, guiiise” argument, or the implication that mental illness isn’t real, to be pretty infuriating (though I’m not angry right now or anything.) It played a great role in making my experience with mental illness significantly more difficult.