Diffing the DSM
Is talk therapy on the “right side of history”?
Imagine that it’s 1980, and you find out hysteria has been finally removed from the DSM (The Diagnostic Statistical Manual, i.e., the tome psychiatrists use to determine what is and isn’t a disorder). You high-five your friend and say, “At last, this sexist stigma has been banished from the psychiatric canon.” (“hysteria” comes from the Greek word “hystera” or uterus.) “Finally, therapy is out of the dark ages.”
Ten years later, in 1990, you find out that homosexuality has been removed from the ICD (The International Classification of Diseases, a tome maintained by the World Health Organization). You high-five your friend and say, “Finally, therapy is out of the dark ages.”
Ten years later, in 2000, some U.S. states legalize marijuana, and it occurs to you that attitudes around drugs have relaxed in recent years, a far cry from the days when “reefer madness” would land you a referral to a therapist. Once again, you celebrate, “Finally, therapy is out of the dark ages.”
If you saw a psychiatrist today, how would you know if you weren’t being explicitly or implicitly labeled with something that will become society’s next “hysteria”? Fortunately, the consequences of getting it wrong are a far cry from the early 1900s. (Look up the sad story of Rosemary Kennedy, JFK’s sister, who, if you read between the lines, was probably diagnosed with female “hysteria.”) But the safety issues are still real since most prescribed psychoactive drugs today, as well as modern electro-shock therapy, carry significant risks of suicide.
Unfortunately, this ironical process becomes less discernible the closer we get to the present. Furthermore, if norm violations are a big part of why people seek therapy in the first place (i.e., “not fitting in”), then not only are you possibly tripping over a blind spot, but also falling down a rabbit hole and breaking your back.
I’ll note, though, that I’m an advocate of talk therapy. I wasn’t at first, but after some hard work, I found a therapist I love (I’ll share some best practices at the end). In the meantime, I cannot emphasize enough how irresponsibly society is navigating when it comes to mental health.