The attempt to catalog all the ways that Americans can go crazy dates at least to 1840, when the Census included a question on “idiocy/insanity.” From those two simple categories, we now have more than 300 separate disorders; they are listed in a 943-page book called the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short. The book is important because doctors, insurers and researchers all over the world use it as a reference, a dictionary of everything humanity considers to be mentally unbalanced.
This week we got the first comprehensive look at what might go into the book’s latest version, the DSM-5. Currently, the DSM is disjointed and disorganized — at times well researched and at times anachronistic. The present version, the DSM-IV-TR , was published in 2000. It begins with “mild mental retardation” moves on to common illnesses like depression and odd ones like dyspareunia and ends with the vague “personality disorder not otherwise specified.” The rhyme and reason behind the DSM have always been murky; the book, like our brains, is a huge, complicated beast. .
5. Rethink the definitions of sexual and gender identity disorders.
Today, heterosexual men can be diagnosed with a supposed disorder called “transvestic fetishism” if they meet only two criteria: they have sexual fantasies about cross-dressing, and those fantasies cause “impairment in social, occupational, or other important areas.” What’s more, the DSM considers aversion to sex a sex disorder, even though the condition has less to do with low sex drive than outsized feelings of fear and avoidance — more like a phobia.
The DSM-5 proposes to update this category by including “hypersexual disorder.” Although the name sounds like something Han Solo might have had, the proposed criteria make sense: sexual fantasies take up so much time that they become repetitive, debilitating and harmful to normal functioning. Also, “sexual avoidance disorder” would be dropped and “transvestic fetishism” would become “transvestic disorder,” although the diagnostic criteria themselves would not change: the DSM still seems to have a problem with cross-dressing.
Overall, the DSM-5 is shaping up to be a much better reference than its predecessor. There will be months of negotiations — anyone can register at dsm5.org to comment, and consumer groups, day-to-day therapists, research psychologists and many others will have a say. But give the APA one thing: it seems to acknowledge, finally, that it is not the sole arbiter of what makes a person crazy.
Read about the science of appetite.
See the cartoons of the week.
