According to The American Psychiatric Association, “The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems).”

DSM5

I had never heard of The DSM before I began researching the Willard Asylum. I had read many old documents about immigrants who were not allowed to disembark the ship because they were thought to be insane. It made me wonder, how were these people behaving that the authorities and physicians, with their six second examinations, determined that they were insane? I wanted to know, what does it mean to be insane? What is insanity? This is when I first learned about The DSM.

The old adage, “What you don’t know can’t hurt you,” isn’t true. This book affects everyone who lives in the United States. It reminds me of the Dependent, Defective, and Delinquent Census of 1880 (Men, Women), when neighbors were asked by census enumerators if their fellow neighbors were insane. The increase in the “defective classes” rose 155 percent between 1870 and 1880. In 1880, there were 6 general forms of insanity. According to The DSM, there are 13 or more categories divided into over 300 disorders. One hundred-fifty years ago we had asylums to lock people away from society and thankfully, those institutions no longer exist. Today, we have television and internet commercials, medical websites, and The DSM telling us we are ill. We are “abnormal.” We self-diagnose without a physician or psychiatrist. We walk in their offices asking for medication, wanting a magic pill, and telling them our diagnoses. It’s all there at our fingertips, all we have to do is look up what ails us and if we have two or three symptoms, then we must be sick. Are we all mentally ill? Should everyone be medicated? Will we re-build the insane asylums of the nineteenth century? How will this end?

The following is an excerpt from DSM 5 In Distress by Allen Frances, M.D., Psychology Today, December 2012: “Except for autism, all the DSM 5 changes loosen diagnosis and threaten to turn our current diagnostic inflation into diagnostic hyperinflation. Painful experience with previous DSM’s teaches that if anything in the diagnostic system can be misused and turned into a fad, it will be. Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age, and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick and given inappropriate treatment.”

(Allen Frances, M.D., was chair of the DSM-IV Task Force and of the department of psychiatry at Duke University School of Medicine, Durham, NC. He is currently professor emeritus at Duke.)