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Why Are People So Interested in the DSM-5?

The views expressed are those of the author and are not necessarily those of Scientific American.


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There is a lot of internet buzz about the approval by the American Psychiatric Association’s (APA) board of trustees of its fifth edition of  the Diagnostic and Statistical Manual of Mental Disorders (DSM-5.)

The APA press release notes “the trustees’ action marks the end of the manual’s comprehensive revision process, which has spanned over a decade and included contributions from more than 1,500 experts in psychiatry, psychology, social work, psychiatric nursing, pediatrics, neurology, and other related fields from 39 countries.”

The approval was announced on Saturday, December 1 (was the APA trying to keep it quiet?) with publication of the DSM-5 scheduled spring 2013.  For a book that has no plot or characters, its pending publication has caused great excitement.  True, it is a sequel, but it is not the latest installment of Harry Potter or the Twilight Saga.

Though the DSMs have not reached the volume of sales of a Harry Potter (so far),  the paperback edition of the last version of the DSM had a sales rank of 261 on Amazon.com.  This is remarkable for a book that is over 900 pages in length and written for professionals.

Besides being bestsellers, the DSMs have inspired games and even music awards. DSM-IV the Game is available for free online.  It is described as “beautiful way to engage and learn about yourself, family, and friends and as an ice breaker at your next holiday gathering.”

Several years ago, Dr. Jill Squyres, a clinical psychologist in San Antonio, created the DSM-IV Music Awards for her professional society’s fall social.  The  DSM-IV Music Awards are modeled on the Academy Awards. She chooses categories based on a DSM diagnosis and then nominates songs that are reflective of disorders such as Major Depression (Jagged Little Pill by Alanis Morisette,  King of Pain by the Police), Mania (Wake Me Up Before You Go Go by Wham, Life in the Fast Lane by the Eagles), Obsessive-Compulsive Disorder (I’m In Love With My Car by Queen, Pinball Wizard by the Who), and Borderline Personality Disorder (Isn’t life Strange by Jim Morrison, Addicted to Love by Robert Palmer).

How does a medical book about psychiatric disorders inspire games and awards let alone become a bestseller? There are not enough medical professionals or people with vested interests, such as the pharmaceutical or insurance industries, to account for these sales figures. What is behind the fascination with the DSM among the general public?   I believe it is because our mental state goes to the core of who we are as human beings and our fascination with the link between mental illness and creativity.

Mental illness went “public” long before cancer and AIDS. Although mental illness is still considered a stigma by the general public, writers and artists have been talking publicly about their bouts of depression and struggles with alcohol and drugs for hundreds of years.  Ernest Hemingway, Virginia Woolf, Sylvia Path and Vincent van Gogh committed suicide. The poets T.S. Eliot and Ezra Pound were committed to mental institutions. The 27 club is comprised of  musicians who died at age 27; Janis Joplin, Jimi Hendrix, Brian Jones, Kurt Cobain, and Amy Winehouse.  The public breakdowns and rants of Mel Gibson, Alec Baldwin, Lindsay Lohan, Charlie Sheen and Mel Gibson have been televised and viewed by millions on YouTube.

The style and language of the DSM is another reason for its popularity. Unlike most medical textbooks , there is relatively little medical terminology and diagnoses are described in terms that are easily understandable to the nonmedical reader. Each diagnosis includes a list of symptoms, referred to as criteria, that typify the disorder. The list of symptoms is exhaustive, but not all symptoms necessarily occur in the disorder. The format and clear non-technical language invite the reader to examine and apply this new knowledge to themselves and others. A parent who worries that his child might have Attention Deficit Hyperactivity Disorder (ADHD) or a spouse concerned that their loved one is displaying symptoms of Alzheimer’s disease can easily look up these disorders and review the symptom check list.

Psychiatric disorders consist of behaviors that are extreme. The same behaviors occur with less intensity or frequency in everyday living. A key symptom of Major Depression Disorder is anhedonia, a failure to find pleasure in everyday life. Anhedonia was the working title of Woody Allen’s movie Annie Hall, which won four Academy Awards including Best Picture. In mild or moderate degrees, most of us have experienced “mild anhedonia” (a.k.a being in a funk) at some point in our lives.

Obsessive-compulsive disorder (OCD)  is an anxiety disorder marked by obsessions, which consist of unwanted and repeated thoughts, or behaviors, and compulsions that make those with OCD feel compelled to perform a behavior to lessen their anxiety. Although most of us are not paralyzed by OCD, we all have some traits. We go back and check to see if we locked our doors or left the tea kettle on. And although we might wish to have the detective skills of Adrian Monk or the writing skills of Jack Nicholson in As Good As It Gets , these fictional characters inability to cope with OCD causes them great anguish and the inability to have significant relationships.

I believe that today’s films and TV shows that portray mental illness are popular because they present characters we can relate to, unlike earlier films such as Psycho, a film that scared people so much they stopped taking showers. We laugh at the neurotic mother-son relationships portrayed in Everyone Loves Raymond and Seinfeld because we can relate to them. And we worry about our children. Are we pushing them so hard that they will end up like Natalie Portman’s crazed ballerina in the Black Swan?

Brain scans have shown that that creativity and “madness” light up similar pathways in the brain. However, the overwhelming majority of mentally ill people are not artists and most artists are not mentally ill.  Edgar Allen Poe, Vincent Van Gogh and Ernest Hemingway were gifted artists who happened to be mentally ill. Their mental illness did not make them artists. In fact, mental illness interferes with the artistic process.  William Styron was not able to write in the throes of his depression. The mathematician John Nash did his greatest work before he was diagnosed with schizophrenia.

I have no doubt that some gifted people are able to function by “throwing themselves into their art.” However, their legacy is their work, not their mental illness. People may fantasize about being able to play guitar like Jimi Hendrix, write like Hemingway, and sing and dance like Michael Jackson. But they don’t fantasize about being clinically depressed, overdosing on drugs, being homeless, or being institutionalized.

To answer to my question of why we are so fascinated by the DSM, I believe it is because it presents and explains extremes of behavior, related to and connected with the more normal levels of behavior we experience. We read the DSM to find ourselves in its pages.

Images: Vincent Van Gogh; Janis Joplin; MONK cover by author.

David L. Levine About the Author: David L. Levine, M.A. is co-chairman of Science Writers in New York and a member of the National Association of Science Writers. As a freelance journalist, he has written for Scientific American, Good Housekeeping, Woman’s Day, BioTechniques, Robotic Trends and Physician's Weekly, where he was a contributing editor for ten years. He has a MA and BA from The Johns Hopkins University. He was director of media relations for the American Cancer Society and held similar posts at the American Lung Association of NY and Cancer Care, Inc. He worked with his colleagues to pass the laws that restricted smoking in New York City and State and banned smoking on all U.S. airlines. He is a member of the American Association for the Advancement of Science and the New York Academy of Medicine. Follow on Twitter @dlloydlevine.

The views expressed are those of the author and are not necessarily those of Scientific American.






Comments 9 Comments

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  1. 1. warnold 10:29 pm 12/6/2012

    Levine offers a good review. With regard to van Gogh, the time course of his medical crises, signs and symptoms, and exacerbation factors are best explained by some sort of toxic psychosis and, in particular, acute intermittent porphyria is an attractive working hypothesis. Dr. Wilfred Arnold, Westwood Hills, Kansas

    Link to this
  2. 2. jtdwyer 6:37 am 12/7/2012

    In my limited experience, the problem with psychiatric diagnoses is that the DSM is so accessible to the casual ‘practitioner’ (anyone so inclined) that everyone can form their own diagnostic opinion about anyone, yet it’s not so precise that professionals can agree on their patient diagnoses. When someone is seriously ill, it’s often quite apparent to everyone they’re in contact with, but effective diagnosis can be difficult. For about 10 years I repeatedly had to seek out care for a seriously ill individual. The diagnosis presented varied markedly mostly based on which professional was performing the diagnosis. While this patient was being cared for at one institution I even received desperate phone calls from a few of the institution’s psychiatrists proclaiming that the patient had been misdiagnosed and was receiving improper care! I did everything I could think of to determine whether proper care was being provided. In retrospect, I probably should have just consulted the DSM and made my own diagnostic determination! Unfortunately, I would not have been able to prescribe treatment…

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  3. 3. HaroldAMaiio 7:58 am 12/7/2012

    Although mental illness is still considered a stigma by the general public

    That is far too broad a statement. It is not an unusual claim, but an exaggerated one.

    Harold A. Maio, retired Mental Health Editor

    Link to this
  4. 4. sjfone 11:05 pm 12/8/2012

    What’s a few yuks over someone having a NP disorder, unless you’re the one wearing it.

    Link to this
  5. 5. Robert D. Stolorow, PhD 1:08 pm 12/9/2012

    Down with the DSM: http://www.psychologytoday.com/blog/feeling-relating-existing/201204/deconstructing-psychiatrys-ever-expanding-bible

    Link to this
  6. 6. Laird Wilcox 8:13 pm 12/10/2012

    There is a good reason why these and other changes are controversial: they have potential legal and even political consequences.

    Every time a new “disorder” is given an official label it’s just a matter of time before it begins showing up in court proceedings. What was not an “illness” yesterday suddenly becomes an illness today. What was an “illness” is no longer considered one.

    Being diagnosed with these “illnesses” can have political consequences. If a political candidate has ever been diagnosed with an “illness” that has a name and it becomes known, it becomes an issue in the campaign. If a new “illness” is used to make or impede a legal case it has law enforcement consequences. It if is used to deny a person specific rights, such as to operate an automobile, purchase a firearm or have custody of children, it has consequences.

    A classic example is the massive campaign to remove various sexual behaviors from the DSM. These were formerly stigmatized and are now “normal.” The reverse process can happen just as easily. It would not be hard to imagine a “homosexual opposition disorder” winding up in the manual by a similar PR process.

    The DSM, perhaps unfortunately, has consequences that affect our lives, our civil liberties, legal due process and even has political consequences. It should not be taken lightly.

    Link to this
  7. 7. drjsquyres 2:46 am 12/11/2012

    Thank you for referencing my DSM-IV Music Awards blog post. I enjoyed reading your post and I hope you enjoyed reading mine! It’s nice to know we can find some humor in something as serious, important and fraught with controversy as the DSM.

    Link to this
  8. 8. Robert D. Stolorow, PhD 12:09 am 12/21/2012

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

    Link to this
  9. 9. themediacollective 1:37 pm 01/20/2013

    What a great article.

    Thank you for linking to our DSM-IV: The Game.

    We are super excited about the DSM-V. A new version of the game will be released in celebration of this wonderful event.

    Link to this

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