Psychiatric disorders: should we trust the “DSM”?

“It allows doctors to speak the same language”

Éric Bui is professor of psychiatry at the University of Caen.

“Harmonizing the diagnostic criteria for mental disorders, via a common manual, allows doctors all over the world to speak the same language. Anyone can say that he or she is “depressed”, but there is a definition of what depression is. And even if there is always a part of arbitrariness in the choice of words, that makes it possible to agree on the terms. When a doctor speaks of depression, a colleague will understand the same thing, namely a sad mood and/or a loss of desire every day, all day, associated with symptoms such as insomnia or hypersomnia, trouble concentrating, appetite, dark thoughts…

→ INVESTIGATION. Mourning, a mental disorder like so many others?

Why is this important? Because when a drug is prescribed, it has proven its effectiveness on patients with a disorder identified according to these same criteria. To return to the example of depression, the proof of the efficacy of an antidepressant is based on its comparison with a placebo administered to patients who present with depression according to the same classification. So if I prescribe an antidepressant to someone who feels “depressed” but does not meet the criteria for depression, I have no argument for the effectiveness of that drug (even if it is still it might work). »

“This manual manufactures mental illnesses”

Patrick Landman is a psychiatrist, founder of the Stop DSM collective.

“If we rely on the DSM, any emotion, any disorder that departs from the norm becomes a pathology to be treated, thanks to a list of catch-all criteria, which do not make it possible to distinguish the real patients from the others. From year to year, with each new version, the DSM thickens. This manual manufactures mental illnesses. Shyness turns into social phobia, simple sadness turns into depression, a restless child who throws temper tantrums is suspected of being hyperactive, an elderly person is diagnosed with cognitive impairment as soon as they have gaps memory… As far as mourning is concerned, the previous version of the DSM considered that experiencing sadness and fatigue several months after the loss of a loved one was precisely not a sign of depression. On the contrary, this grief was normal. Things have since evolved.

→ TESTIMONIALS. They lost a loved one: “It was four years ago, it’s like six months”

What I blame this manual for is that it leads to overdiagnosis, overprescription, overmedication, driven by pressure from pharmaceutical laboratories. To stick labels and make people fit into boxes. This classification is too nourished by theory, not enough by clinical practice and knowledge of the field, the human, the history and the environment of the patients. »


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