Changing the Definition of Mental Illness

For better or for worse, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is used as a core learning tool in social work programs across the country. Currently, I am taking a psychopathology class at UCLA where students are taught the basic criteria for differentiating groupings of mental disorders (i.e. thought vs. mood disorders), and how social workers might begin to formulate diagnoses for patients/clients in various practice settings.

In order to keep readers informed about the revisions to the DSM, I wanted to mention two of the more prominent changes expected to appear in the fifth version of the DSM, which is due out in 2013. Last November, the DSM task-force announced that 5 personality disorders will be removed. Ironically, narcissistic personality disorder will be among the personality disorders axed from the manual. More recently, psychiatrists have debated the inclusion of hypersexual disorder and compulsive gambling as official diagnoses.

As a social worker, I am disappointed in what little discussion there is regarding the role of culture in conceptualizing mental disorders in the DSM. Currently, cultural considerations are a mere afterthought in the manual, and any considerations to this issue are thrown in the appendix of the DSM. A mere 7 pages are devoted to the topic in the 943-page manual!

Because there is such a dire need to contextualize mental disorders with cultural considerations, I wanted to applaud Jonathan Metzl, a psychiatrist at The University of Michigan, who just released a new book called The Protest Psychosis: How Schizophrenia Became a Black Disease. Metzl evaluated hundreds of patient records, studies, and pharmaceutical advertisements to uncover how and why schizophrenia is over-diagnosed in African American men. I believe this is a must read for every mental health professional, and a great way to start the discussion on how and why we need to expand cultural considerations in the DSM. In the following video, Metzl explains the root cause of how Schizophrenia came to be over-diagnosed in African Americans:

How Schizophrenia Became a "Black Disease"