The Diagnostic and Statistical Manual of Mental Disorders (DSM) is considered the bible for many mental health practitioners, particularly in the field of psychiatry. The DSM was published in 1952, with the fifth iteration releasing in 2013 and a slight text revision being made in 2022. What was purported as an attempt to categorize people’s mental anguish, by way of labeling problematic mental symptoms, has unfortunately turned into a weapon that not only pathologizes normal human experiences but justifies the prescription of psychoactive drugs.

The creation of the DSM and its modern-day popularity reflects how mental anguish has become medicalized, defining human thoughts and feelings as “medical or psychiatric problems.” Normal human experiences like anxiety, for example, have turned into “Generalized Anxiety Disorder” and “Social Anxiety Disorder.” Feelings of depression is often categorized most notably as “Major Depressive Disorder.” In many ways, to suffer is now to be a victim of some disorder or neurological ailment. The reason that psychiatry, and clinical psychology, went down the route of medicalization was to separate themselves from their humanistic roots and, instead, garner legitimacy in the medical community by becoming a “science.”

As a consequence, the field of psychiatry, and some of psychology, have cultivated a profession that treats the mind like a medical doctor treats the body. In other words, mental anguish is the result of imbalances among neurotransmitters in the same way that diabetes is the result of low insulin or drowsiness is the result of lowered blood pressure. Conflating the mind with the body, and treating the complexity of human suffering with pills that tamper with neurotransmitters, is both a flawed and harmful perspective.

Certain psychiatric disorders are not observable on any brain scan and there remains no causational evidence of a particular neurotransmitter being linked to abstract mental states like happiness, sadness, or apprehension. “Mental illness” is a term that plays into the idea that mental anguish is akin to physical ailments and the term is not only demonstrably misleading, but it also induces a level of victimized helplessness.

The DSM and in turn the field of psychiatry, as well as some branches of psychology, ultimately pathologize normal human behavior. In the ream of “mental health,” it has become nearly impossible to suffer or experience mental anguish without being labeled as mentally ill or a victim to some psychiatric disorder that needs to be cured. It almost feels like it’s a crime to experience things that might be deemed negative, such as sadness or apprehension.

Considering that the mind is arguably the embodiment of our existence, exemplified by the saying “I think therefore I am,” then the pathologization of the mind can be seen as victimizing our very existence itself. This victimization induces a level of helplessness, believing one’s mental anguish to be a disease and thus out of one’s control. This deliberately primes people into surrendering themselves to the mercy of the cure that much of psychiatry and clinical psychology presents: psychoactive drugs.

The most harmful effect of the DSM is its tendency to encourage and justify the use of psychoactive drugs to alleviate problems for which it has labeled and pathologized as such. For every “mental disorder” that is defined, a series of accompanying drugs are purported to alleviate it. Anti-depressants like Prozac and Selective Serotonin Reuptake Inhibitors (SSRI) for depression, Benzodiazepines (sedatives) for anxiety, and so on. Whether or not your feelings of depression or anxiety require the use of drugs is therefore not only determined by the DSM, which involves a series of boxes to be checked off, but is at the discretion of your psychiatrist who may often require the administration of such drugs, following diagnosis, in their treatment programs.

A popular historical example of the way that the DSM encouraged drug-use, at the onset of its creation, was with the use and rise of antidepressants. While both the DSM and anti-depressants came out in the 1950s, the latter struggled to find a market given that depression was not yet identified as a medical disorder. As a result, people were not inclined to use pills to alleviate their feelings of depression.

It was only until the 1980’s (In the DSM-III) that depression as a disorder was officially labeled and standardized, coinciding with the introduction of SSRI’s. Unexpectedly, a significant jump in anti-depressant use was seen in the 1990’s as SSRI’s became both normalized and mainstream. The rise of anti-depressant use has continued alongside the expansion of the DSM and the handing out of psychiatric labels, with one in six adults in the United States being prescribed some sort of psychiatric drug.

The problem isn’t only that psychiatric drugs are being prescribed on false or deceitful pretenses, but that their supposed curative effects often turn out to be far worse than the problem it’s administered to alleviate. Akin to drugs for physical ailments, many psychiatric drugs create dependency and lead to a chain reaction of side-effect, encouraging patients to be on multiple psychiatric drugs at once to combat their associated negative effects. 

What makes such harm even more troubling is that it’s being prescribed on something that isn’t physically observable – such as mere feelings of apprehension – and is at the mercy of the interpretation of the one making the diagnosis. Often, the victims of said drugs are also young and impressionable people who unknowingly turn their mental anguish into a life-long battle of physical and mental problems born from their psychiatric drug use. This is why the subject of the DSM and overmedication of the human mind is something that ought to be talked about and challenged, particularly in the face of its increasing normalization and promotion by both governments and corporations.

References:

1. Conrad, P., Slodden, C. (2013). The Medicalization of Mental Disorder. In: Aneshensel, C.S., Phelan, J.C., Bierman, A. (eds) Handbook of the Sociology of Mental Health. Handbooks of Sociology and Social Research. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4276-5_4

2. Kawa S, Giordano J. A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: issues and implications for the future of psychiatric canon and practice. Philos Ethics Humanit Med. 2012 Jan 13;7:2. doi: 10.1186/1747-5341-7-2. PMID: 22243976; PMCID: PMC3282636.

3. Terlizzi EP, Norris T. Mental health treatment among adults: United States, 2020. NCHS Data Brief, no 419. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:110593.

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