What began with the best intentions as a means for creating a standardised nomenclature, permitting a basis for research -- you can't work out effective treatments if no one can agree as to what it is you're treating -- has become, instead, a basis for rationalising insurance payments and granting a patina of scientific cover for institutional dispositions of people, and a profit centre for the pharmaceutical industry.
Instead of a useful language text, opening up research conversations, the DSM has become a tool for generating profit.
Critics point to its increasing medicalisation of the essential human process of grieving into the categories of depression for which insurance companies pay providers and for which drug companies can offer medications as treatment.
The respondents to the Peoples' Review (2017) cited as objection the over-reliance on medication -- and they're correct to do so. Too often folks who come for help, when finally they see a doctor, are given medication as the therapeutic agent, as if these pills will somehow magically cure the very human ills that bring people to our doors.
For most of these people, the drugs do not work. Don't get me wrong -- medication can be very effective in the treatment of serious disorders, the psychotic disorders and the grave depressions. But even here, their side effects require close monitoring.
For the greater number of people with mental health issues, the medications are of limited value and other treatments -- talk therapy, diet and physical therapies -- are more effective and have fewer side effects.
A disquieting fact is that for most of the medications authorised by the US Food and Drug Administration, the required studies only cover the first three months of use. It's often years before such serious side effects as diabetes-type 2 are discovered.
I have prescribed medications in many instances, and I hope and believe that careful use of anti-psychotic and/or anti-depressant medications can be helpful and effective as a part, but only as a part, of an overall treatment.
In an environment in the US where the medications bring in many billions in profits and the DSM at US$199 a copy generates between $4 million and $5 million annually for the APA, it's time to be very sceptical, particularly as the results of all that money spent have been none too good in the US.
We need to start over -- not exactly with a clean slate but certainly with an inquiry, one that reveals our assets and our liabilities. An inquiry with an open-minded spirit and a willingness to pursue the truth, wherever it may lead ... hopefully to a better set of treatment paradigms arising out of our own fertile soil of imagination.
Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.
