I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.
Until now, the American Psychiatric Association seemed the entity best equipped to monitor the diagnostic system. Unfortunately, this is no longer true. D.S.M.-5 promises to be a disaster — even after the changes approved this week, it will introduce many new and unproven diagnoses that will medicalize normality and result in a glut of unnecessary and harmful drug prescription. The association has been largely deaf to the widespread criticism of D.S.M.-5, stubbornly refusing to subject the proposals to independent scientific review.
New diagnoses in psychiatry can be far more dangerous than new drugs. We need some equivalent of the Food and Drug Administration to mind the store and control diagnostic exuberance.
I don’t know about an organization like the FDA -but I agree there should be more oversight in how diagnoses are determined and there should be more scientific rigor. I remember when talking with past APA president and author of the book Destructive Trends in Mental Health: The Well Intentioned Path to Harm, Nicholas Cummings, that he mentioned that psychiatric diagnoses were just made by consensus of the task force. This is hardly science and it should be, at least as much as possible.