The Moving Goalposts of Mental Illness

The latest edition of the manual psychiatrists use to assess patients has gone through a major and controversial set of changes. 

The latest edition of the manual psychiatrists use to assess patients has gone through a major and controversial set of changes which according to a report published in Current Biology (open access) runs the risk of:

“..moving the goalposts for mental disorders, the 158 experts preparing the manual on behalf of the American Psychiatric Association (APA) may make patients of millions of people who were hitherto considered normal.”

Common problems that were considered normal and may now be medicalised include normal grief after bereavement, harmless forgetting in advanced old age, excess worrying and overeating. Asperger syndrome has been removed and shifted in to the broader category of autism spectrum disorder. According to Al Frances, the chair of the taskforce that produced the previous revision (DSM-IV):

“My concern is that diagnosing the worried well diverts attention from the really sick. Redefining everyday problems as mental disorder underestimates human resiliency; burdens the individual with harmful medication and stigma; narrows personal horizons; costs a fortune; and creates the false sense we are a sick society.”

The new paper raises the issue of “the fundamental conflicts of interest that haunt the field” that may create perverse incentives towards medicalising the normal:

“Understandably, psychiatrists who investigate a hitherto unappreciated mental problem will lobby to get their hobby horse into the manual. Moreover, the pharmaceutical industry has a natural interest in widening the patient population, as this will boost their sales.”

For further reading regarding these issues check out the Pulitzer Prize winning Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by Robert Whitaker (a book that I just can’t recommend any more highly, it is positively riveting) and Crazy Like Us: The Globalization of the American Psyche by Ethan Watters. In May to coincide with the release of DSM-5 Al Frances will be releasing Saving Normal, a discussion on the issues discussed above.


Gross, M. (2013). Has the manual gone mental? Current Biology (Vol 23 No 8). doi:10.1136/bmj.f1580

Image Credits: Image adapted from Shutterstock/lineartestpilot & Vadym Andrushchenko

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