If the basic logic of the DSM is flawed, it should be abandoned. Instead, psychiatrists should move towards a system that looks at an individual’s mental experiences in context, alongside their unique developmental vulnerabilities and strengths, as the main source for analysing and responding to their distress. Diagnosis would no longer name a disorder but map what kinds of support, relationships and learning processes are most likely to help a person regain agency, coherence and a sense of future.
That’s an idiotic take. Do you think the average psychologist is equipped with that level of emotional intelligence? Not even one in twenty
Unsurprisingly [email protected] is banned from my instance (probably for lib shilling?) so I can’t reply directly.
But just because the APA admits that their science is trash, that doesn’t mean that we need to respect their science. It doesn’t mean we should use their pseudo-science as a basis for health care, etc. That’s the point.
The problem is laymen (including insurance) treat it as a bible…
It’s a descriptive guide. But just because people don’t understand it’s purpose, doesn’t mean it’s useless.
If someone thinks it’s useless, they just don’t understand it, or it’s short history over the many different revisions.
I mean… insurance companies also treat it like the bible, as do many psychologists. It would be useful to have guidance like “these are symptoms that tend to present together” but that’s not how the DSM is written.
I mean… insurance companies also treat it like the bible
Yes… I literally just said it in the comment you replied too…
The problem is laymen (including insurance) treat it as a bible…
It would be useful to have guidance like “these are symptoms that tend to present together” but that’s
Literally how the DSM is written and what it is for…
Full circle back to the problem being insurance and other laymen not understanding it…
What exactly is the part you think needs changed?
Sorry, you said insurance and I missed it somehow. I agree that laymen and insurance companies treat it as a bible, but I also think that’s how the APA presents it. If the goal is to compile “symptoms that tend to present together” the DSM does a poor job of making that clear.
I have several problems with the DSM. This isn’t an exhaustive list but off the top of my head:
-It’s based on the idea that there’s a clear line between “normal” and “disordered” mental functioning, and that we can quantify all of a person’s experiences to land on either side of that line. There are a handful of diagnoses that are discrete enough for me to say “you either have it or you don’t” but the majority of them are so arbitrary that they’re not useful. Mood disorders are especially vague.
-Inter-rater reliability is notoriously poor. I can diagnose anyone with a disorder to argue medical necessity for therapy.
-It includes conditions that cannot and should not be diagnosed by mental health professionals, like narcolepsy. It’s good for providers to know what narcolepsy is, but unless they’re going to include every other medical condition, I don’t know why they include the ones they do.
-DSM-5 broadened the criteria for several disorders, possibly to increase access to insurance coverage, but it’s edging ever closer to categorizing every human experience as a disorder. According to DSM-5, if you’re having depressive symptoms for more than 2 weeks after a loved one dies, it’s no longer grief and it’s considered a major depressive episode. When people criticized that bereavement clause, DSM-5-TR included “prolonged grief disorder” which extends the time you can grieve the loss without a MDD diagnosis. But grief is absolutely a normal response to loss, and sometimes it can be really disruptive and long-lasting. Why are we pretending that’s disordered?
-The majority of every DSM task force has been older white men, and we should be very skeptical of what they consider normal or not.
sometimes it can be really disruptive and long-lasting. Why are we pretending that’s disordered?
Because if it’s “really disruptive” then a person might need support to be able to function well enough to, e.g., keep a roof over their head. Insurance companies require a label in order to pay out for that support, so there it is. If you’re grieving for 2 weeks plus 1 day, but still able to function, no one is going to arbitrarily slap a diagnosis on you.
Fwiw, “disordered” doesn’t necessarily mean abnormal in the context of mental health, it really just means causing problems (or, “really disruptive”). Indeed, it’s normal to grieve for more than 2 weeks, but our broader society is geared toward extracting profit from you, not toward making sure you can work through your emotions, so mental health professionals are often stuck with just trying to facilitate the least-bad outcomes. Also, as you said, sometimes the changes are just to appease insurers; the system is dumb, so sometimes you have to do nonsensical things in order to make it help people like it should.
As for narcolepsy/etc., yeah … As a mental health professional, I am also befuddled. I suppose a psychiatrist with appropriate training could diagnose and treat that, but normally it would be a sleep specialist.
Tl;Dr: the healthcare system itself doesn’t make sense, so we do things that don’t make sense in order to make it work for patients.
but I also think that’s how the APA presents it.
Well …
You’re wrong. Sorry to be blunt, but you’re just not getting it
Abstract The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders. Since a complete description of the underlying pathological processes is not possible for most mental disorders, it is important to emphasize that the current diagnostic criteria are the best available description of how mental disorders are expressed and can be recognized by trained clinicians. DSM is intended to serve as a practical, functional, and flexible guide for organizing information that can aid in the accurate diagnosis and treatment of mental disorders. It is a tool for clinicians, an essential educational resource for students and practitioners, and a reference for researchers in the field. (PsycInfo Database Record © 2025 APA, all rights reserved)
https://psycnet.apa.org/record/2013-14907-000
Like, the APA can’t be more explicit that the DSM is not what you think it is…
And you just fucking insist that we take your word on what they say it is
But you’re wrong.
There’s nothing to debate here, there’s no discussion or interpretation.
That’s the abstract for the DSM written by the APA. I have no idea where you are getting the shit you’re saying from.
You are talking to a bot. That’s why it missed an obvious keyword in your initial message. ‘somehow’
It becomes useful for claiming services. Like here if you have Autism you get special classroom support, disability payments, respite services for the family, etc. That wouldn’t happen if you had Bob disorder, unique from Joe disorder.
Yeah but that’s not science. That’s just pseudo-scientific politics.
People shouldn’t receive treatment based on fake science.
A good therapist, psychologist and psychiatrist treat the person anyway, the DSM is just a guide.
For example: If a person with Emotional Dysregulation gets a Borderline Personality Disorder diagnosis based on 5 or 7 criteria on the list the therapy is going to focus on their key issues. And let’s say they aren’t a cutter, the therapist isn’t going to say hey let’s discuss anti self harm strategies, if that person doesn’t self harm.
Also its not fake science it is statistics, which is a real science and is in the title of the manual.
Worth knowing:
Article’s byline is “Jim Van Os” , and the Wikipedia article for someone of the same name is a Dutch psychologist who has a ten-year history of arguing that “schizophrenia” isnt a useful label.
https://en.wikipedia.org/wiki/Jim_van_Os
(Of course, as far as I know they may not be the same guy, and I don’t have any reason to doubt the sincerity of his argument.)
Who cares? It’s not a useful label. That’s the point.
The whole DSM is a pseudo-scientific grift that serves capitalism, hegemony, etc., rather than producing positive results through actual science.
Look at the history of the DSM. It’s full of phony bullshit just like it is now.
