Is It Time for a New Approach to Emotional Suffering? |
For decades, the Diagnostic and Statistical Manual of Mental Disorders—the DSM—has shaped how mental health is defined and treated in the United States. It now lists nearly 300 “mental disorders,” an enormous catalog meant to organize human distress into neat categories.
Before addressing some of the possible shortcomings with the DSM, let’s look at the benefits. A DSM diagnosis can:
Help you make sense of your suffering. DSM categories break down distress into familiar patterns, making overwhelming feelings more understandable and easier to talk about.
Reduce feelings of shame. You may feel relief when you realize that depression and anxiety are not personal flaws, but recognized medical conditions shared by millions.
Identify a number of real biological disorders. Conditions like schizophrenia and bipolar disorder clearly reflect underlying brain abnormalities. Accurate diagnosis and treatment are vital, and the DSM helps guide that process.
Enable access to care. Insurance reimbursement often requires a DSM diagnosis. Without it, many people, especially lower-income individuals, would struggle to get therapy or medication.
Support educational and workplace accommodations. Diagnoses such as ADHD or learning disorders make it easier to obtain extra time on tests, assignment flexibility, or workplace adjustments, so you don’t need to “prove” the legitimacy of your struggles.
Despite these substantial strengths, the DSM has some potential weaknesses as well. Many DSM categories do not describe genuine brain abnormalities, but the ordinary, painful, and sometimes overwhelming human emotions.
Take generalized anxiety disorder (GAD), for example. The DSM defines it as worrying about at least two things, on more days than not, for six months. This seems to imply that at midnight of the 183rd day, you suddenly qualify for a diagnosis that you did not have five minutes earlier.
This time rule is not grounded in biology or logic; it’s based on the vote of a committee. Human emotions just don’t flip from “normal” to “disorder” on day 183. Worrying—like sadness,