384 Chapter 11 Psychological Disorders
outraged many mental health professionals, who
objected to the blurring of the symptoms of nor-
mal bereavement with those of severe depression
(Greenberg, 2013). To the editors of the DSM-5,
depression is depression, whatever generates it. To
the protesters, this change turns an understand-
able and universal reason for human sorrow into a
mental disorder (Horwitz & Wakefield, 2007).4
The illusion of objectivity. Finally, critics both
inside and outside of psychiatry maintain that
the whole enterprise of the DSM is a vain attempt
to impose a veneer of science on an inherently
subjective process (Frances, 2013; Houts, 2002;
Kutchins & Kirk, 1997; Tiefer, 2004). Without
objective tests for mental disorder, many decisions
about what to include must be based on group
consensus—a vote by leading psychiatrists and clin-
ical psychologists. This group consensus reflects
prevailing attitudes, which may include cultural
prejudices. It is easy to see how prejudice operated
in the past. In the early years of the nineteenth cen-
tury, a physician named Samuel Cartwright argued
that many slaves were suffering from drapetomania,
an urge to escape from slavery (Kutchins & Kirk,
1997; Landrine, 1988). (He made up the word from
drapetes, the Latin word for “runaway slave,” and
mania, meaning “mad” or “crazy.”) Thus, doctors
could assure slave owners that a mental illness, not
the intolerable condition of slavery, made slaves
seek freedom. Today, of course, we recognize that
“drapetomania” was foolish and cruel.
Watch the Video drapetomania: Robert Guthrie
at MyPsychLabperson’s behavior. Suppose that a rebellious, disobe-
dient teenager is diagnosed as having “oppositional
defiant disorder” or that a child who has repeated
tantrums is given the new DSM-5 diagnosis of “dis-
ruptive mood dysregulation disorder.” Having the
label suggests that the problem results from some
inherent disposition—a “mental” disorder, after all.
But perhaps the teenager is defiant because he has
been abused or ignored. Perhaps the “dysregulated”
child has outbursts only with certain adults or in
certain situations, or has parents who have failed to
set behavioral limits. Yet once a child or teenager is
labeled, observers tend to ignore all the times and
situations in which he or she is behaving beautifully.
On the other hand, many people welcome
having a diagnostic label applied to them. Being
given a diagnosis reassures those who are seek-
ing an explanation for their emotional symp-
toms or those of their children (“Whew! So that’s
what it is!”). Some people even come to identify
themselves according to a diagnosis and make it
a central focus of their lives. Many people with
Asperger’s syndrome have established websites
and support groups, and have even adopted a
nickname (“Aspies”). What happens, then, when
the label vanishes? The DSM-5 has removed
Asperger’s as a specific diagnosis, enfolding it into
the spectrum of autism disorders, over the pro-
tests of many people who want the label.3
The confusion of serious mental disorders with
normal problems. The DSM is not called “The
Diagnostic and Statistical Manual of Mental
Disorders and a Whole Bunch of Everyday
Problems.” Yet each edition of the DSM has added
more everyday problems, including, in DSM-5, “caf-
feine intoxication” and “parent-child relational prob-
lem.” Some critics fear that by lumping together
everyday difficulties with true mental illnesses such
as schizophrenia and major depression, the DSM
implies that life’s ordinary problems are comparable
to serious mental disorders (Houts, 2002).
A related concern is that the DSM-5 has loos-
ened the criteria needed for making a diagnosis,
thereby increasing the number of people who can
be labeled with a disorder. The DSM-5 has added
binge-eating disorder, whose symptoms include
“eating until feeling uncomfortably full” or “when
not feeling physically hungry.” Who would not
receive this diagnosis on occasion? One of the
most vehement protests regarding the DSM-5
was on just this issue of moving the goalposts for
a diagnosis. In the past, people who were grieving
over the death of a loved one were not considered
to have clinical depression, unless the grief became
prolonged or incapacitating. However, the DSM-5
removed the “bereavement exemption” from
the diagnosis of major depression. This changeHarriet Tubman (left) poses with some of the people
she helped to escape from slavery on her “underground
railroad.” Slaveholders welcomed the idea that Tubman
and others who insisted on their freedom had a mental
disorder called “drapetomania.”