As I was driving to work this morning, the radio newsman announced that today was the big day for the release of the DSM 5. The Diagnostic Statistical Manual of Mental Disorders is now in its fifth revision, but it does not come without controversy. In fact, most of the comment on the radio was about the idea that the American Psychiatric Association is turning somewhat normal human behavior into diseases that will need treatment.
Several examples of overreach were given including diagnosing widows with major depression after a couple of weeks, binge eating disorder, and disruptive mood dysregulation disorder. Until today, widows were allowed at least 2 months to grieve the loss of their husbands and now they will be considered depressed when they meet the criteria in as little as two weeks. Binge eating is something that I can relate to going back to the days when my mother would make whole plates of oatmeal cookies that would be washed down with ice cold milk. But, I draw the line at disruptive mood dysregulation disorder.
That is professional jargon for a tantrum. I understand tantrums entirely as I have 12 wonderful grandchildren. I think I have seen them all manifest the problem at one time or another. Their behavior was not a disease and did not require anything more than some loving attention from their parents. In all 12 cases the symptoms were short lived and responded quickly to parental guidance.
The question posed by the radio announcer is a valid one. Do we need to turn every difficult struggle that we face into a disease? And, even further, do we need a prescription solution for it? Not all parts of the civilized world deal with behavior and emotional problems the way we do.
In “Psychology Today” Marilyn Wedge has written an interesting article that addresses the difference between children raised in France and in the U.S when it comes to the diagnosis of ADHD.[i] The amazing difference is that while 9% of children in the US are diagnosed and medicated for ADHD, in France around a half percent of
children are diagnosed. Her question was why doesn’t ADHD exist in France as it does here?
Her answer was that parenting in France is different than it is here today. Remarkably, the French pay more attention to the boundaries around their children’s behavior. They set them and then they enforce them with discipline. Wedge also noted that the French psychiatric community deals with childhood behavior issues differently. They have refused to follow the DSM since the third revision and have their own criteria. Those criteria discount the idea that ADHD
is only a biological issue and instead looks at the family/social setting to find the cause and cure for the behavior. And, the French are quite happy with it.
On this inaugural day for the DSM 5 there are important questions that we need to ask and answer. Do we really want to make another acronym diagnosis out of normal childhood behavior? Do we really want another 9% of our children taking a mood stabilizer medication because we or they cannot regulate their disruptive moods? Or, is it time that we like the French part company with the DSM and take a long hard look at how raising children in the U.S. has changed over the past 5 decades?
Maybe a good solution would start with the final observation that Dr Wedge made concerning the difference between French and American Children. “…it makes perfect sense to me that French children don't
need medications to control their behavior because they learn self-control early in their lives. The children grow up in families in which the rules are well-understood, and a clear family hierarchy is firmly in place. In French families, as Druckerman describes them, parents are firmly in charge of their kids—instead of the American family style, in which the situation is all too often vice versa.”[ii]
Prior to 1960, American children we raised much the same way. Maybe what we are seeing is not an epidemic of disease, but a paradigm shift in parenting. I suspect the solution is not more diagnostic categories and more medication but a return to normal parenting.
[i] http://www.psychologytoday.com/em/89888“Why French Kids Don’t Have ADHD,”