The bible of mental health, updated

Tiger Woods, we now know, isn't just another horrible excuse for a husband. He may in fact suffer — poor man! — from the troubling disorder known as "hypersexuality."

And the child throwing a fit in the supermarket? Clearly a case of "temper dysregulation with dysphoria."

We have gained these valuable new insights thanks to recently publicized proposals to revise the Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, that expansive bible of the mental health profession. A public feedback period, lasting until April 20, will culminate in the fifth edition of the DSM, with an expected publication date of 2013.

Each new iteration of the endlessly tinkered-with manual can be counted on for a few punch lines, not to mention grist for the mills of the culture war. (You know, further evidence of our decline into a "therapeutic society" lacking the grit and backbone of the good old days.)

All sarcasm aside, though, the DSM has a tremendous effect on American society, shaping policy in schools, workplaces and the courts, and carrying huge implications for the insurance industry. As Dr. Michael First, a professor of psychiatry at Columbia University who edited a previous edition to the manual, put it to the New York Times, "Anything you put in that book, any little change you make, has huge implications not only for psychiatry but for pharmaceutical marketing, research, for the legal system, for who's considered to be normal or not, for who's considered disabled."

The manual is consequential on a personal level to be sure. Especially if it is your child, your spouse, your loved one who could benefit from an appropriate mental health diagnosis and then the ensuing treatment.

But the DSM also has profound social and political ramifications as well. Consider the mark mental health — untreated and over-treated — has on society. The Department of Justice's Bureau of Justice Statistics has reported that more than half of all prison and jail inmates have mental health problems. It's not a leap to believe that treatment might have prevented a good percentage of the crimes that landed these prisoners behind bars. Instead of a burden on the public purse, these prisoners might have become taxpayers.

But to recognize mental illness is to invoke the responsibility to do something about it. And for more than 30 years, treating the mentally ill out of public funds has not exactly been a popular proposition.

So, my plea is that we don't squander this moment of spotlight on mental health.

Understanding the human mental condition is a lot like learning a new language. The more you learn, the more you understand how little we know.

Revisions of the DSM typically reflect new research as disorders are recognized, others are recategorized, and old beliefs are refuted.

The manual's classifications and labels are a start; attitudes and policy follow. Our understanding of depression, bipolar and eating disorders like anorexia nervosa and bulimia have leapt forward in recent years.

Or consider the ways in which our understanding of autism has evolved. The term Asperger's syndrome wouldn't have been widely recognized years ago. Now it is being considered for inclusion under the umbrella terminology of "autism spectrum disorders." The phrasing represents a more nuanced understanding understanding: People categorized as autistic have a wide array of abilities and challenges, and it's important for the public and for policy makers to grasp that.

For better or worse, the public has an uneasy relationship with psychiatry. It wasn't that long ago that lobotomies and shock therapy were considered standard treatments. Until 1973, the American Psychiatric Association listed homosexuality as a mental illness. And yet we readily see that so much human pain is not addressed because of superstitions, misinformation and lack of access to adequate, competent mental health care.

So rather than dismissing the new entries to the DSM as so much psychobabble, let's recognize this enterprise as the record of a long, steady march toward greater mental health.

Mary Sanchez is an opinion-page columnist for The Kansas City Star. Readers may write to her at: Kansas City Star, 1729 Grand Blvd., Kansas City, Mo. 64108-1413, or via e-mail at

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