California Healthline Daily Edition

Summaries of health policy coverage from major news organizations


      Is the Diagnostic and Statistical Manual of Mental Disorders
(DSM) a classification of scientifically described mental
ailments, or is it, as some critics say, a book that "medicalizes
many behaviors once considered traceable to character flaws?"
According to the New York Times, DSM critics charge that the
increasing number of disorders described in the manual is tied
directly to its "far-reaching influence on health care spending."
Dr. Thomas Szasz, author of "The Myth of Mental Illness," said,
"Inclusion in the DSM is the key that opens the strongbox; you
cannot bill for treatment without using it." Accordingly, Szasz
said the DSM "has ingeniously made itself indispensable and
probably indestructible."
Times notes that mental health advocates are lobbying
Congress and the states to guarantee equal coverage in health
plans for mental disorders, leading critics to label the DSM "a
powerful marketing machine that slices off ever-greater chunks of
money from overall health care spending." Herb Kutchins, a
social work professor at California State University in
Sacramento, said, "There is a clear motive for defining new
mental disorders and marketing psychotropic medications for
adults." Kutchins noted that "as recently as 18 years ago, the
DSM had only 106 mental disorders," compared to the more than 300
now listed. As a result, he said "less money is available to
treat those with serious, debilitating mental illnesses whose
sufferers have little clout." The Times article discusses
several mental illnesses that may be included in the next DSM,
such as "road rage" and pre-menstrual dysphoric disorder.
According to the National Institute of Mental Health, "one-
third of Americans suffer from a clinical mental disorder in any
given year and that more than half will have one during their
lifetime." Mental health advocates say that classifying these
illnesses as treatable disorders "removes the stigma from seeking
treatment." Kutchins, however, said, "If full parity comes about
and only half of the people who would qualify for a DSM disorder
seek professional treatment, the tab has been estimated at about
$75 billion a year" (Sharkey, 9/28).

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