Deakin ethicist calls for new approach to mental illness classification

Dr Tamara Kayali Browne, from Deakin's School of Medicine, makes the case for an independent ethics review panel to evaluate future changes to the Diagnostic and Statistical Manual of Mental Disorders (DSM), in a paper recently published by the journal Philosophy, Psychiatry & Psychology.

"How do we decide what emotions, thoughts and behaviours are normal, abnormal or pathological? This is essentially what a select group of psychiatrists decide each time they revise the DSM, a bible for mental health professionals worldwide," Dr Browne said.

"Questions like these are unavoidable and cannot be answered by science alone.

"This point was famously demonstrated when homosexuality was de-classified as a mental illness in the DSM in 1973. The decision was not based on new scientific evidence but came about due to pressure from activists."

The DSM was first published by the American Psychiatric Association in 1952 to create a common language and standard criteria for the way we classify mental disorders.

Since its inception, it has continued to be widely used around the world by clinicians, researchers, insurance and pharmaceutical companies, the legal system, health regulators and policy makers.

Now in its fifth edition, revisions have gradually expanded the number of mental disorders, while also removing some as understanding or values change.

Dr Browne said many of these amendments had courted controversy over the years.

"These days, criticisms of the DSM are that it medicalises normal behaviour such as fidgetiness, noisiness and shyness," she said.

"Currently, three temper tantrums a week, negativity, irritability and anger would qualify a child to be labelled with Disruptive Mood Dysregulation Disorder.

"The label assumes first that the child is suffering from a problem, and second that the problem is pathological.

"Yet one may also question why it is the child who must be labelled and not the parents. For example, why do we not have a diagnosis called Inability to Discipline One's Child Disorder?”

Dr Browne said what the "problem" was, and who was judged to be the party "suffering" from it, were value judgments that carried with them the cultural biases and assumptions of the individuals making those judgments.

"If we don't examine value judgments properly, we risk making judgments that are discriminatory or harmful," she said.

"This is why our process of classifying mental illnesses should involve experts for whom examining value judgments is their bread and butter.

"Philosophers could identify and deliberate the value issues, sociologists could present the possible social consequences of proposed changes, and ethicists could make the complex harm/benefit analyses and ethical trade-offs that will inevitably be involved."

Dr Browne said her proposed solution was based on the idea that psychiatric diagnosis should serve an ethical purpose - relieving certain forms of suffering and disease.

"In light of this ethical purpose, we must do our utmost to consider value judgments that can cloud our view of 'illness' and how it should be treated," she said.