Psychiatry’s Bias Problem

The Association for Women in Psychology (AWP) is continually analyzing and advocating about bias, particularly gender-related, in psychiatric diagnosis, but they’ve got their eyes on the prize these days: the DSMV, set to be published in 2013. For those who aren’t familiar, the DSM, Diagnostic and Statistical Manual of Mental Disorders, is essentially the bible of psychiatry, the manual by which folks are diagnosed and prescribed treatment. As you probably already know, there have been various controversies about the ways in which disorder is defined and the ways in which various facets of personality, genetics, and a mix of the two are pathologized. There have been five revisions since the DSM was first published in 1952. Each version is concurrent with a new battle over which disorders should be removed and which should be added. These seemingly logistical questions are actually wrestling matches over meaning, culture, gender, sex, race, and science.
The AWP has a series of articles that break down some of the most pressing controversies facing us with this new version of the DSM, including: “Anorexia Nervosa and the DSM, Borderline Personality Disorder: The Disparagement of Women through Diagnosis, Female Sexual Dysfunction Diagnoses, Gender Interupted: Controversy and Concerns about Gender Identity Disorder (GID), Should Obesity Be Called a Mental Illness?, Problems with Parental Alienation Syndrome, and Social Class and Classism in Psychiatric Diagnosis.”
In sum, there are a lot of red flags this time around, not the least of which is the current DSM committee’s “fortress-like mentality.” The AWP explains:

In addition, despite the secrecy surrounding the process, additional alarming information about what committee members are considering has already appeared. For instance, a committee was appointed to consider whether “racism” should appear in the DSM-V, a step that would disguise a social evil by making it seem “merely” an individual problem, a mental illness. One danger of such a diagnostic category is that people who commit hate crimes would blame their crimes on alleged mental illnesses and thus avoid criminal punishment (Profit, 2004). This is similar to the category of “rapism,” which was proposed for DSM-III-R and which feminists successfully battled (Caplan, 1995).

So what do we do about it? Unfortunately, because of the secrecy and bureacracy involved, it’s difficult for the layperson to advocate. The AWP has created this clearing house for information on bias in the next edition, in an attempt to inform its members and the press as quickly as possible when things go awry:

Unfortunately, many changes in past editions have been made at the last minute and without the public’s knowledge, so that serious problems have become widely known only after the editions were published; those problems have persisted for many years. Indeed, in the case of the widely publicized claim in the early 1970s that “homosexuality” was being removed from the next edition of the manual – a claim that is still generally believed to be true – it emerged that “ego-dystonic homosexuality” actually remained in the next edition after all (Metcalfe & Caplan, 2004).[1] Situations like this make it difficult to think how to protect the public and how to educate the public and professionals about ways to stop the DSM-V authors from causing harm. We hope that this website will provide some resistance to the DSM-V steamroller.

We’ll certainly do our part to follow this story and keep the Feministing community informed.

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7 Comments

  1. MLEmac28
    Posted January 28, 2010 at 3:49 pm | Permalink

    I had a discussion with a friend who is a psych major about “Gender Identity Disorder” recently.
    On the one hand, I do think that being born in the wrong body certainly sounds like a disorder of some kind. If the person had been born in the correct body to begin with, it would probably mean a lot less distress on their part. Of course, I think the Gender Identity disorder diagnosis is actually defining the identity as incorrect, e.g. the physical body is correct and the person has a mental illness which makes zir think ze was born in the wrong body. That, of course, is a problem.
    In many ways, I want there to continue to be some kind of medical diagnosis for transgender people, which would make it a lot easier to fight to get insurance companies to pay for the transition. It’s already considered along the same lines as plastic surgery by most insurance companies. If there is no longer a medical diagnosis for it, getting insurance companies to pay for it would be even harder.

  2. femme.
    Posted January 28, 2010 at 3:55 pm | Permalink

    Thank you for keeping up with this issue, Courtney. The bias entombed in the DSM is unacceptable and we need to put as much public pressure as we can on those who are responsible for its revision.

  3. Lydia
    Posted January 28, 2010 at 6:50 pm | Permalink

    Reminds me of a poster I saw on the subway the other day. It was one of those calls for participants in psychiatric studies. This one said in big letters “Do you not like the way you look?” (or something like that) and went on about how if you’re a woman or girl who has nevative feelings about her appearance, you might be qualified to participate in a study about a new possible disorder that’s being researched. Forgot the name but it was basically a fancier, more psychobabbly way of saying “not liking the way you look.”
    I could believe my eyes. I’d always thought that if there is anything that is generally accepted to be a result of cultural and societal influences, it is the insecurity that many women experience about their bodies and appearances. But not now, apparently. Women don’t have issues with their looks because they’re continuously bombarded with images of women that are so photoshopped that they increasingly portray physiques that don’t even exist. Or because they’ve been taught all their lives to define themselves based on their outward appearance as opposed to their talent or brains. It’s because they’re sick! After all, we always knew that most women are batshit insane.
    Ugh. I am increasingly amazed by the medical community’s ability to trivialize the very real problems that women face by finding ever more creative ways to tell women that it’s all in their heads. Don’t even get me started on borderline personality disorder or “PMDD.”

  4. AMM
    Posted January 28, 2010 at 11:30 pm | Permalink

    My problem with the GID diagnosis is the same as the AWP’s: it defines gender identity in terms of the extent to which one’s behavior and preferences fit into the stereotypes for “male” or “female”. A boy who likes to play with dolls is assumed to be manifesting a “female” identity, a girl who hates dresses and insists on pants is assumed to be “male.” (I don’t know what they’d do with a girl (or boy) who wants to grow up to be a princess who plays for the NFL.) I see the GID diagnosis as a way to pathologize people who don’t fit.
    Now I can see your point, too. If transition is the best way to make somebody’s life better, you don’t want the DSM-n to stand in the way.
    These are really flip sides of the same problem. I worry that people will get “treatment,” not because they need it, but because they make Society uncomfortable. You worry that people won’t get the treatment they need because that treatment (or what that treatment is for) makes Society uncomfortable.

  5. Brianna G
    Posted January 29, 2010 at 7:26 am | Permalink

    When my partner was younger he believed he was female. However, in his case it was not due to gender dysphoria (a term I actually prefer, as it implies that there’s a disconnect between the mind and the body but doesn’t clarify which is a problem), but rather a combination of child sexual abuse and his mother attempting to raise him with female gender roles because she believed that men were rapists. Extensive therapy, and he now has no problem with his male identity and is actually pretty heteronormative. He has many friends who are transgender (whom he met when seeking support at that time), absolutely accepts that there are real transgender people, etc, but the point is– some people who believe they need to transition actually have underlying conditions that are causing it.
    I worry that if gender dysphoria is de-medicalized, people like my partner would be able to go and get surgery without psychiatric interveiws, and thus many people who are actually psychotic, were abused, have dissociative identity disorder (whether psychiatrist-induced or not), or are just incredibly confused about their gender role and position in society could wind up with irreversible surgery they didn’t need that won’t solve their problem. Even if it’s a neurological condition, I think that gender and sex are so confusing and so wrapped up in society and environment that it’s too risky to allow anyone to go ahead with such a complicated and dangerous process without serious evaluation of their mental state and confirmation that it is the actual need. Especially since doctors are beginning to realize the importance of early, pre-pubescent intervention in gender dysphoria cases.

  6. Brianna G
    Posted January 29, 2010 at 7:37 am | Permalink

    Having known someone who was diagnosed as borderline– she definitely had something wrong. It prevented her from functioning. She attempted suicide many, many times. It wasn’t like restless leg, or self-image issues, which one can simply compensate for, or which can be traced to societal concerns– she was unpredictable even to herself, engaged in self-harming behaviors, and could not prevent herself from hurting her own chances at success through manipulating people, hurting others, impulsive behavior and mistrust. She knew it was a bad idea but had no impulse control.
    There is no society on earth she could have functioned in, even one expressly created for her. Every day was a struggle to keep her ALIVE, even though she didn’t want to die– I have no idea what happened to her, she was institutionalized. There are some conditions that seem questionable, and maybe BPD is overdiagnosed. But there are definitely individuals who meet the criteria, don’t meet the criteria for other conditions, and cannot function because of it. I think that’s the most important thing to consider with any disorder– does it seriously impair the individual’s functioning, regardless of the environment or society they are in or the people they are with? If yes– there is something wrong.

  7. Lydia
    Posted January 29, 2010 at 3:22 pm | Permalink

    Brianna, I am not arguing that people diagnosed as borderline often have serious problems. I suppose throwing it in there with PMDD and “hating-your-looks-itis”, which I do think are pretty much bogus, made that confusing. My main problem with the borderline diagnosis is more that it often results in the problems being located in the “sick” brain as opposed to viewing the problems as coping mechanisms or natural responses to external factors (such as past abuse etc.). Men who exhibit the same symptoms might just be seen as deeply damaged people and better helped, while women are pathologized–and stigmatized–as being sick.
    There is an article about BPD in the list that this post links too which I think explains a lot of the problems well. Check it out.

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