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As we prepare for this month's publication and dissemination of the Diagnostic and Statistical Manual of Mental Disorders, America's biggest-ever helping of psychiatric diagnoses, it's good to recall the many writers who have warned us - who continue every day to warn us - against the outrageous diagnostic inflation it generates.  These would include people like Allen Frances, Marcia Angell, Gary Greenberg, and Christopher Lane -- all eloquent and (given the moneyed interests they're up against) rather brave defenders of our right to a psychiatric-diagnosis-free life, our right not to make our children and ourselves dependent on sometimes dangerous pills in response to our family physician having thumbed through the DSM and told us that we have a mental disorder when we do not . 

The outrage at the DSM's medicalization of normal human experience - grief, shyness - is international. Like the US, many European countries have what can only be called insane rates of psychotropic drug use, complete with the soaring rates of drug abuse that always accompany this.  At a news conference in Australia the other day, where doctors gathered to denounce the DSM, one medical school professor called the ever more massive book "psychiatric imperialism." 

The political metaphor feels right: After decades of passively accepting the authority of the DSM, both experts and citizens have suddenly risen against it. 

It's worth asking why this fury at the DSM is so intense and increasingly widespread.  And it's worth wondering why, given the fact that the upcoming DSM is the fifth, people haven't rebelled before.
The simple answer to the latter question is that it takes a while for a population to get hooked on the idea that pretty much everyone is mentally disordered and in need of powerful pills; and it takes even longer for people to see what a pilled up society actually looks like.  It takes a while for large numbers of people to perceive the characteristics of the world that pharma. pharma television commercials, and  pharma-captured doctors have created:  An unseemly dependence on experts and chemicals, crushing medical expenses, lifelong stigma, serious side-effects; and the tendency of one's pills to be, after all, not much more effective than placebos.

More deeply, people eventually begin to perceive the destruction of the proud American tradition of autonomy - all those passages from Thoreau that thrill us... Where did that go?  Are our only choices toxically disaffected Tea Partiers for whom the idea of autonomy has twisted into paranoia, or pseudo-depressives who've handed control of their very life narrative over to pharmaceutical companies?  Decades ago, in books like The Culture of Narcissism, Christopher Lasch anticipated the grotesque outcome that finally has large numbers of us sitting up and paying attention - we are a country rapidly moving toward a situation in which half the population will be considered - will be persuaded to consider itself - mentally disordered.

This is an excellent turn of events for holders of pharma stocks - as this Forbes writer points out, with refreshing honesty.  It is catastrophic for most of the rest of us who want - who should want - who used to want - the freedom to live our own lives, by our own lights, and not be reduced, defined, and warped by a general practitioner paging through an "epistemic prison."
The most hopeful sign that the DSM and the intimate imperialism it represents are on the way out is not so much the rage this latest iteration is provoking even before its release.  Rather, it is the ridicule of the entire enterprise we've seen in the last few weeks, reflected in books like The Diagnostic Manual of Mishegas and in a group of artists calling its recent show DSM-V.  Only in this way do you get it done; only in this way does culture affirm its capacity to resist the solemn joke on us all that is the DSM. 


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