ARE WE ALL MAD ?

[maria angelica sassone]

 

For BBC World, BBC World, Updated : 05/08/2010

The new manual of the American Psychiatric Association could reduce the category of mentally healthy select few.

"Man with a look of anxiety "

The world of psychiatry is up in arms . The publication of the new draft manual of mental diagnosis of American Psychiatric Association has generated a kind of open battle in a guild that one would expect responses measured and calm.

The so-called Diagnostic and Statical Manual of Mental Health, is considered the bible of psychiatric diagnosis and research worldwide .

Now its fifth version, the DSM -5 , contains the many psychological disorders and deviations have been recorded in recent years.

But for many psychiatrists has expanded both categories and has become a chewing gum so wide that fear they have forever blurred the boundaries between mental illness and the shrinking space of those considered normal.

Now a scientific journal, the Journal of Mental Heath , publishes a special issue dedicated to this topic raised in the open if after the launch of the new parameters someone may be considered normal.

Conditions such as mixed depressive anxiety disorder, adjustment of temperament, binge , lower neurocognitive disorder , addictive behaviors may be sophisticated names still being illogical behaviors are completely normal. Or if not normal , if that, at least , widespread.

Insufficient research

As argued in the journal the problem could arise that has not been investigated enough to consider these disorders as something abnormal.

"Critics of the DSM are concerned about the classification of novel conditions and psychological disorders. In the new edition, the tantrums of a child and the pain resulting from the loss of a loved one may be defined as mental health problems , "writes Jerome Wakefield , Department of Psychiatry of New York in the publication of Mental Health.

For example, binge disorder is based on the criterion of someone who gives binging once a week for at least a period of three months.

For many , this sets a threshold too low. At the end of the vast majority may feel guilty of having a toxic relationship with food at least once a week.

Although, as explained to BBC World Professor Jerome Saiz , president of the Spanish Society of Psychiatry, " There will certainly be more conditions, not only this but the disorder have a significant impact on the balance of the individual , which no interference on their normal lives on their physical health, their weight. What can be more arbitrary is to set time limits . "

Previous Edition

The problem with this manual , which is guided almost the diagnosis of disease worldwide , is that each of the changes occurring in its editions have a global impact , often loved and others totally intentional .

One of the greatest critics of the new manual is the person who was in charge of the previous edition , DSM -4 , published 16 years ago.

In an editorial in the Los Angeles Time, Frances Allen , said a few months ago "I learned through painful experience how small changes in the definition of mental disorders can create huge and unintended consequences. "

He asserts that , even if your discussion group was conservative and careful, inadvertently contributed to the creation of three false epidemics since the last edition to now attention deficit disorders , autism and bipolar disorder in children is diagnosed more than it should .

"Two children "

The importance of the manual should not be overlooked even in a specialty that depends only on the symptoms.

" In our specialty, are purely clinical diagnosis , according to symptom clusters . In other branches of medicine can be contrasted by means of complementary examinations and tests or imaging tests , but in psychiatry there is a parameter that is objective that is capable of admit or exclude the diagnosis , "says Saiz.

And the official diagnoses are more important than we think .

"He has great consequences when legal proceedings or sick leave , "says Saiz.

"In a country like the United States the diagnosis is very important because it will determine the possibility that the person can claim coverage to health insurance , which is not happening in Europe , "he told BBC Professor Til Wykes, a clinical psychologist and Rehabilitation , Institute of Psychiatry at King's College London and Editor of Journal of Mental Health.

And some people seem to suggest the monumental benefits for the pharmaceutical industry can bring a medicalization of behaviors that are on the verge of pathology.

Preventive

As in everything, there are detractors and others not so .

For the existence of the manual Saiz has positive aspects because " the classification provides a universal language, facilitates research, the treatments reach a more uniform and practice and from that point of view the initiative is worthwhile. "

He warns that the new version is still a draft that is open to revision " and that any person , professional, patient , patient or family can send their suggestions for changes. "

For Professor Wykes "most of the changes in the new version involves a more inclusive diagnostic system where the sea of normality is shrinking into a mere puddle . "

But both agree: if you have hobbies, you think you talk about when it is , clings to magical beliefs , has superstitions , believes his boss is against you or found to have closed the door 20 times before leaving home, while These quirks do not interfere with daily life, you are still a normal person.

We do not know for sure is to time.

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