Expanding mental diagnoses: the legal rub

As part of its revision of its influential Diagnostic and Statistical Manual, the American Psychiatric Association is proposing to lower diagnostic thresholds for some conditions and recognize other entirely new (and sometimes controversial) disorders. That will have implications for the coverage of the Americans with Disabilities Act and other laws, as I explain in a new post at Cato at Liberty. (& Alkon, Alex Adrianson/InsiderOnline)


  • The Committee who is working on DSM-5 are the experts in the field. The DSM diagnoses do not represent the views of a single person. Rather they are the views of the collective wisdom of all involved.

    There will always be debates concerning the subject matter of the DSM, but the DSM remains the standard. That is so whether it has the side effect of increasing or decreasing litigation. The problem is the laws and not the expanded diagnoses in DSM-5.

    With that said, there was rumor within the psychiatric community that many of the expanded diagnoses from DSM-III to DSM-IV were put there for billing purposes and not because of truly new conditions.

  • IIRC, these DSM revisions were initially, and astoundingly, being done in secret. Is this still the case?

  • Psychiatry is unique. It is the only branch of medicine whose practitioners render diagnoses without benefit of physiologic tests. When, perchance, a “mental illness” is found to have a biological basis, it immediately ceases to be a “mental illness” and is no longer treated by psychiatrists. (Epilepsy, gastric ulcers, etc.) It is the only branch of medicine which has a committee deciding not what causes an illness, but whether something is an illness at all. Masturbation was, and then it wasn’t. Homosexuality was, and then it wasn’t. These are the sorts of issues the “experts in the field” are pondering in the latest DSM. Since the diagnoses in the DSM are used for the insurance codes that determine whether and how much psychiatrists are paid, you can bet that the list will not shrink (so to speak).

    Look no farther than the lead editor of DSM-IV, psychiatrist Allen Frances, for a frank assessment of the work product of the “experts.” He says: “there is no definition of a mental disorder. It’s bullshit. I mean, you just can’t define it.”

    Thomas Szasz couldn’t have put it more concisely.


  • @VMS: Be that as it may, do you think the slime mold type of lawyer won’t be out there saying, ‘See! See! The DSM says you did/didn’t do what you were supposed to do. Give me money!’

  • BTW: I apologize to slime molds. They are inoffensive, rarely mendacious, and never advertise on billboards.

  • DSM = 1000 pages of weasel words. They have labored mightily to bring forth a popcorn fart worth of intelligence that has a startling grip on the legal mind. It has the effect of a religion where the sinners can label their demons, proclaim victimhood and demand mercy. Here’s the treatment for something called Frotteurism: “Treatment typically involves psychotherapy aimed at uncovering and working through the underlying cause of the behavior.” How do we measure that scientifically? The book has this same treatment plan for almost everything under ‘sexual disorders.’ Though chemical castration is sometimes indicated for pedophilia.

  • To paraphrase Justice Potter Stewart, it seems the solution is “I know mental disabilities when I see them,” at least in those who work on the DSM.

  • VMS trumpeted the expertise of those putting together the new DSM, effectively saying, “trust them – they know what’s good for all of us.” What s/he didn’t tell you is that only psychiatrists are the “in” group in this process. Paychologists, clinical social workers, licensed professional counselors, etc., are being kept out of the process in the creation of DSM-V. In the past, clinical psychologists particularly have been quite involved. Seems like a nice little turf war beginning to take shape between the two APAs. Talk about a narrow (egotistical) approach!

  • […] My new podcast at Cato discusses the American Psychiatric Association’s ongoing project of redefining and often loosening the criteria for diagnosing mental illness, and some of its legal implications in fields like disability law (earlier). […]