Psychiatry in Australia is enjoying unprecedented growth and pre-eminence, embodied in such initiatives as beyondblue, the Black Dog Institute, the Brain and Mind Research Institute, and the Orygen Youth Health Research Centre. Leaders in psychiatry are constantly sought after for talkback radio and TV programs. Indeed, the honouring of Professor Patrick McGorry, pioneer in adolescent mental health, as the 2010 Australian of the Year is testament to the current prestige of psychiatry.
But there is a downside to all this public prominence and exposure: the inexorable medicalisation of mental health and a concomitant focus on the scientific limitations of psychiatry.
At the core of psychiatry is the Diagnostic and statistical manual of mental disorders (DSM) — a document produced by bodies of distinguished professionals, after much debate.
* Carey B. Revising book on disorders of the mind. New York Times 2010; 10 Feb.
The DSM is
“psychiatry’s encyclopedia of mental disorders, the guidebook that ... draws the line between normal and not normal, between eccentricity and illness, between self-indulgence and self-destruction — and, by extension, when and how patients should be treated”.*
However, the DSM also has profound social implications. To quote Dr Michael First, Professor of Psychiatry at Columbia University:
“Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who’s considered to be normal or not, for who’s considered disabled”.*
The DSM is currently being revised, and a proposed addition is a new descriptor of sex addiction — “hypersexuality”. Furthermore, rape fantasies leading to sexual assault may be redefined as a mental illness, with profound implications for the criminal justice system. The list of psychiatric re-engineering goes on.
We have to wait until 2013 for the release of the revised DSM, but, in one sense, it looks likely to continue to point to the limitations of psychiatry’s scientific foundations for disorders of the mind.
The Medical Journal of Australia
Martin B Van Der Weyden, Editor.- Martin B Van Der Weyden