13 Feb

Jason Brien. 

     The American Psychiatric Associations (APA) decision to hastily introduce the diagnostic and statistical manual 5th edition (DSM-5) in 2013 was met with harsh criticism from psychiatrists, psychologists and other mental health professionals around the world. The professionals were concerned with how little outside input and influence the APA allowed prior to publication of the DSM-5 and the inclusion of more psychiatric disorders which were not clinically or professionally supported. For example, the DSM-5 introduced 14 new psychiatric disorders;

1. Binge Eating Disorder

2. Caffeine Withdrawal

3. Cannabis Withdrawal

4. Central Sleep Apnoea

5. Disinhibited Social Engagement Disorder

6. Disruptive Mood Dysregulation Disorder (DMDD)

7. Excoriation (skin picking) Disorder

8. Hoarding Disorder

9. Hyper-sexual Disorder

10. Premenstrual Dysphoric Disorder

11. Rapid Eye Movement (REM) Sleep Behaviour Disorder

12. Restless Leg Syndrome

13. Sleep-Related Hypo-ventilation

14. Social (Pragmatic) Communication Withdrawal

     REALLY???? Besides all of the other psychiatric disorders and conditions that have carried forward from the previous DSM editions, the APA felt that 14 more disorders was necessary. Humans have the capacity to manifest an unlimited range of behaviours. Therefore, one way of looking at psychiatric disorders is as a selection (or biased choosing) of a finite amount of behaviours which people may display at any given time (well in terms of the DSM-5, typically the set of behaviours need to be manifested for at least 6 months in order for the disorder to be considered 'real' and 'pervasive' however over the course of a lifetime an infinite range of behaviours is possible). This chosen set of finite behaviours is then labelled, for example, as Hyper-sexual Disorder, Disruptive Mood Dysregulation Disorder (DMDD) or any other disorder as outlined in the DSM-5. 

     The problem is though, attaching these labels (whilst useful in the sense of understanding how certain combinations of behaviours can impact an individuals daily functioning) is very limiting and very disadvantageous to the individual. The diagnosed individual is essentially being put into a box of which there is little to no escape. All of their other positive behavioural manifestations take a back seat and receive much less focus, validation and attention compared to the more negative, and sometimes not even prominently displayed, behaviours. 

     So what does this have to do with bamboo eating Pandas? The diet of the Pandas early ancestors was much wider than it is today. All manner of plants and insects were on their menu. However, for whatever reason, the pandas diet became so highly specific that bamboo became the single menu item. Not just any species of bamboo either. Only one or two of the many bamboo species available are actually eaten by pandas. Just like the pandas, the APA is seeking to restrict and minimise human behaviour from a wide ranging and infinite range of behaviours into finite, highly restrictive behavioural combinations. 

     Why? Because from the perspective of the APA, confining humans to finite and restrictive behavioural combinations (psychological labels) makes them easier to control and classify. Just like plants and animals. Furthermore, the diagnosed individuals are becoming just like the pandas. They go from being able to display an infinite range of behaviours to being reduced to a subset of behaviours of which they now must adopt as their primary identity. To the outside world, the diagnosed individual goes from a living and breathing flesh and blood human being into an abstract entity created wholly by a handful of people. 

     Think of how demoralised the diagnosed individual must feel. How unreal and depersonalized they must feel. To go from a someone to a something all for the sake of being more easily understood by medical professionals and others. All so that others can focus on a small subset of behaviours that they display. After all, this is much easier and requires less effort than it does to take the time to really get to know someone and witness their whole range of behaviours without judgement. Of course, the majority of therapies are time constrained thus it is much easier and more convenient for the therapist/psychiatrist/psychologist to focus on a small set of behaviours rather than an entire individual. It is much harder to see that yes an individual may display a degree of unpleasant behaviours however they also have a lot more to them. Humanity is capable of so much yet we can be limited not just by ourselves but by others. When we discard the use of labels we can go back to valuing and appreciating people for being imperfect yet wholly lovable beings.

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