Although the DSM started as a manual for practitioners, the lists of symptoms associated with its diagnoses are commonly known to the general public. Through exposure to direct-to-consumer advertising, health-focused websites, and the news, just about everyone can now diagnose themselves, their friends, and their family members — if not the coworker or ex-lover who drives them ‘crazy’ — with little regard for the professional parameters intended to guide the use of the DSM.

With the expansion of the internet and easy access to health information, many are diagnosing (and re-diagnosing) themselves, but how many of these self-care aficionados actually receive mental healthcare? Presently, the need for services outstrips by a wide margin their availability. Yet, how many avoid seeking treatment because the DSM, and the mental healthcare field in general, fails to resonate with their experience of psychological suffering, or suggests solutions that clash with their values or lifestyle?

Within the field of mental healthcare, a central concern is the reliability and validity of the DSM, which are important benchmarks for any scientific document. Yet the DSM is being used in ways that extend beyond scientific parameters as well as its architects’ intent, including the construction of a sense of self, if not an identity, by consumers of mental healthcare information.  And in the 21st century, identities have become one of our most prized possessions.

In his book, The Geopolitics of Emotions, Dominique Moïsi (2009) made a useful distinction between the 20th and 21st centuries:

In the ideological atmosphere of the twentieth century, the world was defined by conflicting political models: socialism, fascism, and capitalism. In today’s world, ideology has been replaced by the struggle for identity. In the age of globalization, when everything and everybody are connected, it is important to assert one’s individuality.

Moïsi’s characterization fits with Thomas Friedman’s (2005) famous assertion about Globalization 3.0:

the dynamic force in Globalization 3.0 — the thing that gives it its unique character — is the newfound power for individuals to collaborate and compete globally.

The shift from ideologies to identities parallels a shift of responsibility (and risk) from institutions to individuals. And this shift has been central to the public dissemination of the DSM as well as the way mental healthcare is practiced today. The last fifty years in the field are distinguished by psychopharmacology replacing extended stays in mental institutions, and one result is that clients are increasingly the guardians of their own mental health and well-being. Consequently, the DSM has become a tool used by savvy consumers to access services, as well as a tool for both creating identities and identifying potential threats to the identities people work so hard to create.

Some of the criticism leveled against the DSM may in part be the result of attending to a new era’s problems with an old era’s ideology — and one that barely passed muster even when ideologies ruled. Diagnoses in the DSM are typically seen as chronic disorders and lifelong conditions, and thus according to the norms guiding medicine, require continual treatment, usually with medications. Research (Whitaker, 2010) shows this approach in psychiatry has led to worse outcomes, more illness, and shorter lifespans. Many would argue these are enough reasons to scrap the project. But even if we only consider its usability as a resource for understanding the nature of psychological suffering, the DSM likely doesn’t serve people who need malleable identities to navigate a rapidly changing world.

Using the distinction between the modern and postmodern, Simon Gottschalk (2000) made this observation:

if we posit postmodern selfhood as a mutable, liminal, multiple, interdependent, and interactive process, then relying on DSM-IV diagnoses will prevent us from understanding it, since DSM-type diagnoses rest on — and reproduce — the idea of a stable, self-contained, and isolated modern self. If the modern self is an obsolete construct … and if the DSM is the most authoritative tool which evaluates such a construct for its ‘deficiencies,’ then, logically, this tool is inappropriate to develop an understanding of postmodern selfhood.

Perhaps at best, the DSM serves psychiatry, which has a long history of seeking validation as a bona fide medical field (and thus has its own identity issues to contend with).

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Image courtesy Stuart Miles / FreeDigitalPhotos.net

Along with personal identities in flux, the nature of emotions may also be changing in response to this latest round of globalization — “globalization 3.0″. In a relatively slow-paced world, one with reliable institutions and the support of extended kinship systems — not to mention affordable housing, universal healthcare, nutritious food, access to nature, time for play, and soul-affirming work — we might enjoy a more “natural” flow of the cornucopia of emotions that are our birthright: feelings of both love and hate, joy and fear, anger and hurt, envy and admiration, and so on—a mixture of feelings flavoring our days and spicing our relationships.

Instead, states of overwhelm and intensity are at risk of becoming new emotional norms. These states are often mixed with a sense of uncertainty, and at times, a wish to avoid feeling anything at all. Kathleen Woodward (2009), author of Statistical Panic: Cultural Politics and Poetics of the Emotions, described this as a state of being caught bouncing between statistical panic and statistical boredom:

I understand statistical panic not as a psychological emotion (anger, jealousy, and grief are notable examples of psychological emotions), but rather as a sensation or intensity, one that is at base a charged anxiety. At the other pole of this structure of feeling is statistical boredom, a state characterized by lack of emotion—one devoid of sensation or intensity.

Woodward associated statistical panic and statistical boredom with how we story our lives, especially around illness. Through chat rooms, blogs, social networks, and health information sites, personal worries about mental health are compared to statistics, symptom lists, and others’ stories of illness. These resources and connections are used not only to commiserate around shared fears, but also to find ways to avoid the risks that contribute to others’ suffering. Given all the information available, and the state of the individual who is suffering, such searches can become a rapid process that lacks depth, clicking between sites, skimming the surface over deep pools of hurt, driven by the anxious fear of pathology. What might start as an effort to self soothe can become a state of exhaustion and emptiness. In the search for feeling better, one can risk feeling nothing at all.

Should Woodward be correct about the 21st century emotional landscape — flat emotions intermittently interrupted by emotional intensity that is quickly forgotten — then the DSM suffers worse than irrelevance; it stands in the way of creating depth in our emotions and our relationships just at those moments when awareness of their absence grabs attention and we ask ourselves, Is there something missing? Is there something the matter with me?

References

Friedman, Thomas L. 2005. The World is Flat: A Brief History of The Twenty-First Century. New York: Farrar, Straus and Giroux.

Gottschalk, Simon. 2000. “Escape from Insanity: ‘Mental Disorder’ in the Postmodern Moment.” In Pathology and the Postmodern: Mental illness as discourse and experience, edited by Dwight Fee, 18-48. London: Sage Publications.

Moïsi, Dominique. 2009. The Geopolitics of Emotion. New York: Doubleday.

Whitaker, Robert. 2010. Anatomy of an Epidemic. New York: Crown Publishers.

Woodward, Kathleen. 2009. Statistical Panic: Cultural Politics and Poetics of the Emotions. Durham: Duke University Press.

About Laura K. Kerr

I am a mental health scholar, blogger and Marriage & Family Therapist Registered Intern (IMFT #65436). My focus is on healing mind, body & soul following traumatic experiences. I also write about the social conditions that contribute to trauma in our lives and the need for reform of mental health services.