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Obscuring root causes[edit]

Economic causes and capitalism[edit]

The DSM-5 has been criticized for overlooking capitalism’s interconnectivity with pathology.[1] One example is the development and treatment of diagnoses: around 69% of psychiatrists involved in the development of the DSM-5 were reported to have financial ties to the pharmaceutical industry.[2] These ties situate many care services within the medical-industrial complex, a framework that prioritizes profit instead of the care of individuals.[3] Lane found the medical-industrial complex intertwined with setting the parameters to diagnose conditions such as social anxiety disorder.[4] Other authors have supported similar findings.[5][6] Kincaid and Sullivan estimate that the cost of the industry surrounding diagnosis will rise to around six trillion dollars by 2030.[7]

Scholars differ in the extent of capitalism's influence on diagnosis. Davies supports the social model of disability in explaining that diagnosis at present relies on considering conditions a consequence of a “broken brain.”[8] His wider logic on mental illness in response to societal issues problematizes diagnosis as a tool of the medical-industrial complex.[8] His previous book, Cracked, demonstrates the market interactions within the medical-industrial complex, as diagnosis becomes a source for monetization. [9]

Others find that the dependency of patients on their psychiatric care providers makes the industry vulnerable to economic exploitation under capitalism.[10] These individuals argue that diagnosis is manipulated, but not caused, by capitalistic forces.[10] Academics have critiqued the directness of the association between the medical model, capitalism, and diagnosis,[11] but generally agree that characteristics of the capitalist system contribute to poor mental health.

Institutional causes[edit]

Diagnoses of mental conditions have been used to obscure institutional practices of discrimination.[12] Late nineteenth-century diagnoses of white women with hysteria, for instance, were said to be caused by “overcivilization,” shaped by racially discriminatory Social Darwinism.[13] Similarly, American physician Samuel Cartwright coined "drapetomania" in 1851 as a mental condition which "caused" slaves to escape captivity.[14] In the present day, Brinkmann finds that “contemporary diagnostic cultures,” whereby humans assess their conditions through a psychiatric lens, can “risk losing sight of the larger historical and social forces that affect [their] lives.”[15] Contemporary diagnostic cultures help explain how diagnosis reflect larger historical biases.[15][16]

Critics have argued that the DSM-5's criteria pathologize a wide range of people with distress or impairment. Chapman et al. discuss the implications for obscuring distress in the incarceration and confinement of "intellectually disabled" populations; they argue that "differentiation based on psychiatric and intellectual disability" is arbitrarily set and altered based on capitalism's needs for "mobile and free workers."[17] Metzl demonstrates that the shifting diagnostic parameters of schizophrenia became a method for institutionalizing Black men during the Civil Rights Movement.[16] In sum, those who have experienced “domination” or “exploitation” based on an identity trait are more likely to be pathologized through diagnosis.[18]

Overdiagnosis[edit]

Allen Frances, an outspoken critic of DSM-5, states that "normality is an endangered species," because of "fad diagnoses" and an "epidemic" of over-diagnosing, and suggests that the "DSM-5 threatens to provoke several more [epidemics]." Some researchers state that changes in diagnostic criteria, following each published version of the DSM, reduce thresholds for a diagnosis, which results in increases in prevalence rates for ADHD and autism spectrum disorder. Bruchmüller, et al. (2012) suggest that as a factor that may lead to overdiagnosis are situations when the clinical judgment of the diagnostician regarding a diagnosis (ADHD) is affected by heuristics.

Concerns raised by DSM-5 critics such as Frances underscore the potential repercussions of excessively broad definitions of mental illness medicalizing the human condition. Psychiatrist Joel Paris contends that psychiatric interventions have become the “cure for unhappiness”, resulting in the overdiagnosis of mental illness.[19] Indeed, data from 2012 to 2018 reveals a 35% increase in diagnoses of mental illness, with notable spikes in eating disorders, anxiety, and depression of 96%, 95%, and 73%, respectively.[20] The rise in diagnostic rates may be attributed to a variety of factors.

Broad Criteria in DSM-5:

An issue of primary concern when considering the causes of overdiagnosis is increasingly broad criteria with each edition of the DSM. Notably, the DSM-V has introduced diagnoses such as Internet Gaming Disorder, characterized by a  “preoccupation with gaming”, eliciting contention regarding the distinction between normative behavior and clinical pathology.[21] Some critics argue excessive gaming is simply a byproduct of societal trends,[22] while others argue it may be representative of underlying conditions such as depression or anxiety.[23] Regardless, such a broad classification poses the threat of pathologizing normal behavior.

Medical Industrial Complex

See full article at Medical-industrial complex.

Another factor that has been cited as potentially contributing to overdiagnosis of mental disorders is financial incentives within the medical industrial complex (MIC). The MIC refers to the intricate and often controversial relationships among pharmaceutical companies, healthcare providers, medical device manufacturers, hospitals, clinics, and other entities within the healthcare industry. These interconnected relationships are driven primarily by financial interests and the pursuit of profits, which can potentially influence medical decision-making, treatment options, and healthcare costs. Specifically, the financial incentives within the MIC prioritize efficiency and profit, contributing to rushed patient interactions and overprescription of treatments.

In 2022, the US healthcare expenditure reached $4.5 trillion, almost 20% of the country’s GDP, creating pressures for greater efficiency and patient throughput. Data from 2018 revealed one in four U.S. physicians spent less than 12 minutes per patient encounter,[24] with clinical staff feeling pressured to increase patient flow in order to maximize their income.[25] The emphasis on efficiency raises concerns about rushed diagnoses and unnecessary treatment, with studies correlating shorter visit times and increased rates of medication prescriptions.[26]

Additionally, the rising costs of healthcare limits access to marginalized groups. Despite research indicating that minority populations such as Hispanic and Black americans contend with heightened stressors predisposing them to mental health conditions,[27] data reveals higher rates of anxiety and depression diagnoses among White americans.[28] This discrepancy suggests White americans are not only more likely to seek care but also more likely to receive pharmacological interventions under the assumption of financial viability and treatment adherence. These trends reflect complex systemic factors influencing diagnostic rates of mental disorders.

Cultural responses to the DSM[edit]

There are several works written in recent years by scholars of the disabled community that specifically critique the cultural impact of the DSM V. These pieces criticize the DSM V from different cultural perspectives, integrating the experiences of disabled people identifying as crip, feminists, Asian Americans, Black Americans and other marginalized viewpoints.

DSM CRIP[edit]

DSM CRIP is a collection of essays by various authors that explore the critiques of the DSM V from feminist and crip perspectives. These essays tackle the critiques of the DSM using specific diagnoses  such as gender dysphoria, transvestic disorder, complex somatic symptom disorder, hypoactive sexual desire disorder, schizophrenia and autism. These are used as case studies to tackle the topics of the potential harm of labels, overmedicalization, overdiagnosis, pathologizing normality and various other critiques informed by the feminist and crip lens.[1]

Open in Emergency[edit]

Open in Emergency is a multimedia collaborative project of the Asian American Literary Review that takes the lens of an Asian American Experience and redefines wellness in terms of care instead of focusing on diagnosis, unlike the original DSM V.  This included mock versions of DSM diagnoses such as gender dysphoria, social anxiety disorder and cannabis use disorder that mean to recharacterize the disorders under the lens of wellness and care.[29] The project was said to contextualize mental disorders with their relationship to structures of power like patriarchy, colonialism and violence (here).

The Protest Psychosis: How Schizophrenia became a Black disease[edit]

The Protest Psychosis: How Schizophrenia became a Black disease is a critically acclaimed book that was written to analyze the history of schizophrenia and how perceptions of the condition have changed. In this book, Metzl shows how the condition of schizophrenia was experienced against the backdrop of the Civil Rights Movement.[30] This book was recognized by the Disability Studies Quarterly academic journal as an excellent analysis of schizophrenia’s link to black history.[2]

Article Draft[edit]

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Article body[edit]

References[edit]

  1. ^ Olivier, Bert (2015). "Capitalism and suffering". Psychology in Society (48): 1–21. doi:10.17159/2309-8708/2015/n48a1. ISSN 1015-6046.
  2. ^ Cosgrove, Lisa; Wheeler, Emily E (2013-02). "Industry's colonization of psychiatry: Ethical and practical implications of financial conflicts of interest in the DSM-5". Feminism & Psychology. 23 (1): 93–106. doi:10.1177/0959353512467972. ISSN 0959-3535. {{cite journal}}: Check date values in: |date= (help)
  3. ^ Magee, Mike (2019). Code blue: inside America's medical industial complex (1st ed.). New York: Atlantic Monthly Press. ISBN 978-0-8021-4687-8.
  4. ^ Lane, Christopher (2007). Shyness: how normal behavior became a sickness. New Haven: Yale University Press. ISBN 978-0-300-14317-1.
  5. ^ Tone, Andrea (January 3, 2012). The Age of Anxiety: A History of America's Turbulent Affair with Tranquilizers (1st ed.). New York City: Basic Books. ISBN 978-0465025206.
  6. ^ Timler, Kelsey (2022). "Distorted Thinking or Distorted Realities? The Social Construction of Anxiety for Women in Neoliberal Late-Stage Capitalism". Hypatia. 37 (4): 726–742. doi:10.1017/hyp.2022.60. ISSN 0887-5367.
  7. ^ Classifying Psychopathology: Mental Kinds and Natural Kinds. The MIT Press. 2014-04-04. doi:10.7551/mitpress/8942.001.0001. ISBN 978-0-262-32243-0.
  8. ^ a b Davies, James (March 3, 2022). Sedated: How Modern Capitalism Created our Mental Health Crisis (1st ed.). London: Atlantic Books. ISBN 978-1786499875.
  9. ^ Davies, James (2014). Cracked: Why Psychiatry is Doing More Harm than Good. London: Icon. ISBN 978-1-84831-654-6.
  10. ^ a b U'Ren, Richard (1997). "Psychiatry and Capitalism". The Journal of Mind and Behavior. 18 (1): 1–11. ISSN 0271-0137.
  11. ^ Barney, Ken (1994). "Limitations of the Critique of the Medical Model". The Journal of Mind and Behavior. 15 (1/2): 19–34. ISSN 0271-0137.
  12. ^ Lebowitz, Matthew S.; Ahn, Woo-kyoung (2014-12-16). "Effects of biological explanations for mental disorders on clinicians' empathy". Proceedings of the National Academy of Sciences. 111 (50): 17786–17790. doi:10.1073/pnas.1414058111. ISSN 0027-8424. PMC 4273344. PMID 25453068.{{cite journal}}: CS1 maint: PMC format (link)
  13. ^ Briggs, Laura (June 2000). "The Race of Hysteria: "Overcivilization" and the "Savage" Woman in Late Nineteenth-Century Obstetrics and Gynecology". American Quarterly. 52 (2): 246–273. doi:10.1353/aq.2000.0013. ISSN 1080-6490.
  14. ^ Hogarth, Rana A. (2017). Medicalizing blackness: making racial differences in the Atlantic world, 1780-1840. Chapel Hill: The University of North Carolina Press. ISBN 978-1-4696-3287-2.
  15. ^ a b Brinkmann, Svend (2016). Diagnostic cultures: a cultural approach to the pathologization of modern life. Classical and contemporary social theory. London New York: Routledge, Taylor Francis group. ISBN 978-1-4724-1319-2.
  16. ^ a b Metzl, Jonathan Michel (2011). The protest psychosis: how schizophrenia became a black disease. Boston, Mass: Beacon. ISBN 978-0-8070-0127-1.
  17. ^ Ben-Moshe, Liat; Chapman, Chris; Carey, Allison C. (2014). Disability incarcerated: imprisonment and disability in the United States and Canada. New York (N.Y.): Palgrave Macmillan. ISBN 978-1-137-39323-4.
  18. ^ Prins, Seth J.; Bates, Lisa M.; Keyes, Katherine M.; Muntaner, Carles (November 1, 2015). "Anxious? Depressed? You might be suffering from capitalism: contradictory class locations and the prevalence of depression and anxiety in the USA". Sociology of Health & Illness. 37 (8): 1352–1372. doi:10.1111/1467-9566.12315. ISSN 0141-9889. PMC 4609238. PMID 26385581.{{cite journal}}: CS1 maint: PMC format (link)
  19. ^ Recovery, Casa (2021-10-13). "The Problem With Overdiagnosis in Psychiatry". Casa Recovery. Retrieved 2024-04-07.
  20. ^ Tkacz, Joseph; Brady, Brenna (November 2, 2021). "Increasing rate of diagnosed childhood mental illness in the United States: Incidence, prevalence and costs". Public Health in Practice. 2.
  21. ^ Starcevic, Vladan (2017-06-01). "Internet gaming disorder: Inadequate diagnostic criteria wrapped in a constraining conceptual model". Journal of Behavioral Addictions. 6 (2): 110–113. doi:10.1556/2006.6.2017.012. ISSN 2063-5303. PMC 5520112. PMID 28301963.
  22. ^ Bean, Anthony M.; Nielsen, Rune K. L.; van Rooij, Antonius J.; Ferguson, Christopher J. (2017-10). "Video game addiction: The push to pathologize video games". Professional Psychology: Research and Practice. 48 (5): 378–389. doi:10.1037/pro0000150. ISSN 1939-1323. {{cite journal}}: Check date values in: |date= (help)
  23. ^ Starcevic, Vladan (2017-03-11). "Internet gaming disorder: Inadequate diagnostic criteria wrapped in a constraining conceptual model: Commentary on: Chaos and confusion in DSM-5 diagnosis of Internet Gaming Disorder: Issues, concerns, and recommendations for clarity in the field (Kuss et al.)". Journal of Behavioral Addictions. 6 (2): 110–113. doi:10.1556/2006.6.2017.012. ISSN 2062-5871. PMC 5520112. PMID 28301963.{{cite journal}}: CS1 maint: PMC format (link)
  24. ^ "Time physicians spent with patient U.S. 2018". Statista. Retrieved 2024-04-07.
  25. ^ Dugdale, David C.; Epstein, Ronald; Pantilat, Steven Z. (1999-01). "Time and the patient-physician relationship". Journal of General Internal Medicine. 14 (S1): S34–S40. doi:10.1046/j.1525-1497.1999.00263.x. ISSN 0884-8734. PMC 1496869. PMID 9933493. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  26. ^ Dugdale, David C.; Epstein, Ronald; Pantilat, Steven Z. (1999-01). "Time and the patient-physician relationship". Journal of General Internal Medicine. 14 (S1): S34–S40. doi:10.1046/j.1525-1497.1999.00263.x. ISSN 0884-8734. PMC 1496869. PMID 9933493. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  27. ^ Thomeer, Mieke Beth; Moody, Myles D.; Yahirun, Jenjira (2023-04). "Racial and Ethnic Disparities in Mental Health and Mental Health Care During The COVID-19 Pandemic". Journal of Racial and Ethnic Health Disparities. 10 (2): 961–976. doi:10.1007/s40615-022-01284-9. ISSN 2197-3792. PMC 8939391. PMID 35318615. {{cite journal}}: Check date values in: |date= (help)CS1 maint: PMC format (link)
  28. ^ "Any Anxiety Disorder - National Institute of Mental Health (NIMH)". www.nimh.nih.gov. Retrieved 2024-04-07.
  29. ^ Khúc, Mimi (2016). Open in Emergency: A Special Issue on Asian American Mental Health. Asian American Literary Review.
  30. ^ Metzl, Jonathan Michel (2011). The protest psychosis: how schizophrenia became a black disease. Boston, Mass: Beacon. ISBN 978-0-8070-0127-1.
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