Building Bridges for Creating change in the DSM

Ricci Levy's picture

In the past few months I've received numerous calls and emails about the revisions to the bible of the psychiatric world - the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short.  The diagnosis in this manual are critically important because they determine who gets diagnosed as mentally ill, who should get powerful psychotropic drugs, and whether and how much insurance companies will pay for care.

The Washington Post quoted Alan Schatzberg, the president of the American Psychiatric Association, "It not only determines how mental disorders are diagnosed, it can impact how people see themselves and how we see each other.  It influences how research is conducted as well as what is researched. . . . It affects legal matters, industry and government programs."

The proposals will be debated in an intense process over the next two years, with potentially billions of dollars at stake for pharmaceutical companies, insurance companies, government health plans, doctors, researchers and patient advocacy groups.

But perhaps more important, the outcome will help shape which emotions, behaviors, thoughts and personality traits society considers part of the natural spectrum of the human persona and which are considered pathological, requiring treatment and possibly even criminal punishment.

Even before being made public, the proposed changes have been the subject of sometimes bitter debate over whether the process was based on solid scientific evidence and was adequately shielded from influence by the pharmaceutical industry, and whether some critics were driven by financial interests in maintaining the old diagnostic criteria.

"There will be adolescents who are a little odd and have funny ideas, and this will label them as pre-psychotic," said Robert Spitzer, a professor of psychiatry at Columbia University, who has been one of the most vocal critics of the DSM revision process.

In addition to classifying the symptoms of grief that many people experience after the death of a loved one as "depression," the proposals include adding "binge eating" and "gambling addiction" as bona fide psychiatric conditions; they also raise the possibility of making "Internet addiction" a future diagnosis. Some critics questioned the proposal to create a "hypersexual disorder."

"How many people with just healthy sex drives will be given that label?" First said.

Each group, each community, is focused primarily on the revision that will most impact their lives. The bdsm community is concerned (and rightly so) with the expanded definition of paraphilias that pathologizes almost everything other than penis in vagina sex. The transgender community is concerned with the expanded definitions of gender disorders (and rightly so). The list goes on.

Each group is working very hard, within their own community, to bring attention to the irregularities in the process of establishing these psychiatric disorder definitions as well as the punishing definitions that will most impact their lives as they express their consensual sexuality and/or gender in the way that is most fulfilling to them. And, once again, "rightly so."


Imagine how much more effective might we be if we combined all of the arguments and demands under the umbrella of sexual freedom as a fundamental human right - seeking the more broad issue under which everyone can find a home and advocate for both their individual issues and the more broad demand that our humanity not be pathologized?

Imagine a petition with ALL the signatures on a list of demands that reflects the concern of each individual group? 

Imagine if, with so much at stake for all of us, we focused on finding the intersections between our concerns and built bridges between our individual focus and sexual freedom as a fundamental human right. 

Imagine the change we might create, the alliances we might form, and the future work we could do together!

The comment period for these revisions closes April 20th.  Time is of the essence!