The Politically Correct Politics of Mental Health – Rewriting the DSM Again

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For years, the left has informed us that the right is interested in shutting down scientific inquiry. As President Obama put it:

Our government [under President Bush] has forced what I believe is a false choice between sound science and moral values … [P]romoting science isn’t just about providing resources – it is also about protecting free and open inquiry. It is about letting scientists like those here today do their jobs, free from manipulation or coercion, and listening to what they tell us, even when it’s inconvenient – especially when it’s inconvenient. It is about ensuring that scientific data is never distorted or concealed to serve a political agenda – and that we make scientific decisions based on facts, not ideology.

Of course, the fact is that the left is most interested in curbing science when that science conflicts with political correctness. From comprehensive sex ed for teenagers (which ignores brain science demonstrating that teens are essentially incapable of regulating risky behavior even when given information about it) to global warming (which apparently causes earthquakes according to vagina expert Eve Ensler) to abortion (in which the actual biological development of fetuses is ignored in favor of niceties about cell clusters) to gay marriage (where leftists idiotically state that men and women are gender constructs), the left is constantly shutting down science in the name of ideology.

Nowhere is this more true than in the field of psychiatry/psychology. The history of psychology shows that it is a political football. Sigmund Freud used psychology to suggest that most personal problems were created by sexual repression. The Frankfurt School, for example, used Freudian analysis to suggest that those who disagreed with them (principally anti-communist fascists and capitalists) were mentally ill, and many of the architects of the Frankfurt School (including Erich Fromm) remain historically prominent voices in the field. It is no wonder that the Diagnostic and Statistical Manual of Mental Disorders, which supposedly embodies the wisdom of the high minds in psychology and psychiatry, is as much a political instrument as it is a health one.

It is important to note, first and foremost, that there is room for fungibility in psychology/psychiatry that there simply isn’t in other health fields. Illnesses are usually self-reported, and diagnosis is often made on the basis of patient self-reporting. The descriptions of afflictions are largely general and difficult to pin down; treatments are very often vague. Take, for example, the DSM-IV’s description of hypochondriasis:

• Preoccupation with fears of contracting, or the idea that one has, a serious disease, based on misinterpretation of bodily symptoms.
• Preoccupation persists despite appropriate medical evaluation and reassurance.
• Preoccupation causes clinically significant distress or impairment.
• Duration of at least 6 months.

Many people would likely fall under this definition who are not actually hypochondriacs. It does not tell you how “preoccupied” you must be with getting sick or being sick; it does not define what “appropriate medical evaluation and reassurance” is; why six months, exactly? The point isn’t that this isn’t the best available definition of hypochondriasis – the point is that the descriptions themselves must be vague, which leaves lots of room for politics.

The current rewriting of the DSM, version V this time, is just as political as past versions. Recall that in 1974, the DSM-II removed homosexuality as a condition, not as a result of research indicating the normality of homosexuality (after all, homosexuality is, was and always will be statistically deviant from the mean, evolutionarily counterproductive, and distressing for many people who engage in homosexual behavior), but because of the supposedly growing “weight of empirical data, coupled with changing social norms and the development of a politically active gay community in the United States.” The DSM-III replaced homosexuality with “ego-dystonic homosexuality,” which was present when someone suffered from persistent lack of heterosexual arousal and persistent distress from a pattern of homosexual arousal. This wasn’t good enough for the DSM, though – that was politically incorrect. The DSM-III removed the disorder in 1986 due to further political pressure.

Today’s psychology textbooks look upon this period as a black mark on psychology, despite the fact that current research does not suggest why exactly homosexuality should be considered normal and unworthy of diagnosis and treatment. The UCLA-utilized textbook Abnormal Psychology: Core Concepts, for example, states:

Reading the medical and psychological literature on homosexuality written before 1970 can be a jarring experience, especially if one subscribes to views prevalent today …

The textbook does admit, however, that “compared with heterosexual men, gay men have higher rates of anxiety disorders and depression, and they are more likely to contemplate suicide … Lesbians also have a higher rate of substance abuse.” Why, exactly, would this factor be ignored in the pursuit of better psychological treatment? The answer is simple: politics.

Nothing has changed in this latest edit of the DSM. DSM-V is largely an attempt to pin down better descriptions of certain psychological states, of course. But there are clearly political influences at work in some areas. For example, the DSM-IV describes pedophilia as follows:

A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

B. The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

C. The person is at least age 16 years and at least 5 years older than the child or children in Criterion A.

This sounds relatively reasonable, although it omits pubescent children completely. Here are the DSM-V’s proposed edits:

A. Over a period of at least six months, one or both of the following, as manifested by fantasies, urges, or behaviors:

(1) recurrent and intense sexual arousal from prepubescent or pubescent children

(2) equal or greater arousal from such children than from physically mature individuals

B. One or more of the following signs or symptoms:

(1) the person is distressed or impaired by sexual attraction to children

(2) the person has sought sexual stimulation, on separate occasions, from either of the following:

(a) two or more different children, if both are prepubescent

(b) three or more different children, if one or more are pubescent

(3) use of child pornography in preference to adult pornography, for a period of six months or longer

C. The person is at least age 18 years and at least five years older than the children in Criterion A.

There is significant definitional variation between the two versions. First off, the new version includes pubescent children. This is good. But that good is outweighed by several negative features. For example, the first version requires only that the person afflicted with pedophilia have acted on his/her sexual urges. The second version raises the bar; now, the person who has acted on his/her urges is not considered a sufferer if he/she has sought sexual stimulation from only one child. That gives you one freebie, pedophiles, before you’re diagnosed. Here’s the rationale provided by the DSM-V writers:

The clauses pertaining to number of different victims may be understood as follows: Suppose that the patient is assigned 1 point for each pubescent victim and 1.5 points for each prepubescent victim. Then Criterion B is satisfied if the patient has accrued a total of 3 points or higher.

Say what? Since when do we get a point system for pedophiles? Are we playing Super Mario Bros. or trying to diagnose people suffering from pedophilia?

The first version also specified that a 16-year-old having sex with a three-year-old is a pedophile; now you have to be at least eighteen to be a pedophile. How convenient. There is little doubt that we are on the path to the normalization of occasional pedophilia under these standards.

Then there is the DSM-V’s proposal to change the diagnosis of mental retardation to “intellectual disability.” This is no doubt a case of good intentions on the part of the psychology/psychiatry establishment – the word “retard” has been slung around so much by folks like Rahm Emanuel that psychologists and psychiatrists want to avoid stigmatizing those who are in fact mentally retarded. It’s good-hearted and I actually agree with the change, but I fear that this will ultimately be ineffective. While well-intentioned, it is an example of political correctness impacting the DSM – over the years, the terminology for the mentally handicapped has changed from idiots, morons, and imbeciles to retards. None of these were originally considered pejoratives (see, for example, Justice Holmes’ sickening opinion in Buck v. Bell, which reads in relevant part, “Three generations of imbeciles are enough”). Once they became pejoratives, we changed the terms. Somehow, that changed terminology hasn’t ended the practice of using medical language to slander enemies.

The new DSM-V proposals also suggest that sex addiction continue to be omitted as a condition (while maintaining gambling addiction). This seems eminently reasonable to me, especially from a layman’s point of view – sex addiction is in all likelihood an excuse for normal men to act like pigs (if anyone has ever met a man who was not addicted to sex, they should notify their local newspaper – it’s a “dog bites man” story). However, we have been told repeatedly by leading psychologists and psychiatrists that prominent figures like Tiger Woods, Jim McGreevey, Bill Clinton, and Eliot Spitzer suffer from sex addiction. How is it these psychologists and psychiatrists can pull it out of thin air to excuse their political buddies while omitting it from the DSM?

Or how about changing the labeling “gender identity disorder” to “gender incongruence”? Gender identity disorder, for those unfamiliar, is when someone feels as though they are male when they are actually female, and vice versa. Here’s the DSM’s explanation for the change:

It is proposed that the name gender identity disorder (GID) be replaced by ‘Gender Incongruence’ (GI) because the latter is a descriptive term that better reflects the core of the problem: an incongruence between, on the one hand, what identity one experiences and/or expresses and, on the other hand, how one is expected to live based on one’s assigned gender (usually at birth) (Meyer-Bahlburg, 2009a; Winters, 2005). In a recent survey that we conducted among consumer organizations for transgendered people (Vance et al., in press), many very clearly indicated their rejection of the GID term because, in their view, it contributes to the stigmatization of their condition.

Does it get any more political than that? First off, this new name suggests that gender is “assigned” at birth, which is total nonsense. Second, it openly acknowledges that the name was changed for political reasons – to placate transgendered people who feel “stigmatized.”

The biggest potential problem with the proposed DSM changes is a methodological one. The new DSM suggests that those at risk of developing mental disorders be diagnosed based on early symptoms, and also suggests a scaled rather than binary scoring system for diagnosis. There is opportunity here – we all want to see true mental illness diagnosed and treated early – but there is also a danger: the overdiagnosis and possible overmedication of normal people based on wishy-washy symptoms, even if the opposite is intended. Even as the psychology/psychiatry field attempts to define certain deviancies away, they lower the bar on what constitutes illness. This has serious ramifications for both public policy (no doubt Democrats will soon be calling for comprehensive public funding of mental health treatment) and private situations (how many people will be put on newfangled pills to solve problems they don’t really have in a serious way?).

I am no psychiatrist or psychologist, and I don’t pretend to be one. I do, however, believe strongly in the field of psychology/psychiatry. Only by removing the politics from the field can it retain its legitimacy. It is imperative that true mental health professionals look closely at the revisions to the DSM and establish whether changes are being made for the good of patients or for the good of liberal causes. The DSM is supposed to be used for classification and treatment, not defining deviancy down or redefining terminology to fit particular political viewpoints. While President Obama may not take his own admonitions seriously when it comes to science, it is the obligation of every psychologist and psychiatrist to do so – if they do not, they put their own credibility on the line.