Tuesday, May 3, 2011

Military Prejudice, Exported to American Culture

Or the history of American psychiatry as a snake-oil scam. This isn't meant to put down those who need services- this is meant to show how we got to a point where there are very few sane people and increasing numbers of insane people with every revision of the Diagnostic and Statistician's Manual For Mental Disorders.

The Diagnostic and Statistician's Manual of Mental Disorders, got it's start way back in 1952, due to the extreme involvement of psychiatrists in draft boards during WWII and Korea. Originally called the "Medical 203 War Department Technical Bulletin", the DSM-I had gone through revisions pushed by the US Navy and the Army, attempting to express "present day concepts of mental disturbance". In 1949, the World Health Organization of the United Nations pulbished ICD-1, the first International Statistical Classification of Disease, which became the numbering system for the DSM-I, which was approved in 1951 and published in 1952. Upon it's publication, it became the gold standard by which Americans were judged to be sane or insane.

The DSM-I was 130 pages long, listing 106 mental disorders, most of which were tuned to "what makes a soldier unfit for combat". Those of us who remember the early years of the TV Sitcom "MASH" will remember the first time the characters of Klinger and Dr. Sidney Freedman met- and the DSM-I was used to fill out Klinger's original Section 8, including transvestitism and homosexuality as his mental illnesses.

The DSM-II was published in 1968, with now 182 disorders and 4 more pages. Symtoms were more detailed, and the American Psychiatry Association adopted it as their manual, applying the new defintion of normal and abnormal to the rest of America for the first time. It also first split diagnosis into neurosis and psychosis, chiefly on a subjective definition of reality and connection of the patient to reality, but no clear boundary between normality and abnormality was drawn.

Due to the studies of Alfred Kinsey and Evelyn Hooker, as well as several protests at APA meetings by gay rights activists, the 7th printing of the DSM-II dropped homosexuality as a disorder and replaced it with the category of "sexual orientation disturbance" in 1974.

For those of us on the autistic spectrum though- 1974 was also the year when the APA decided that a new revision was necessary, and so over the next six years the DSM-III was written. When it was published in 1980, autism was almost an unknown disorder, often misdiagnosed as schizophrenia or something within that grouping of psychosis. The DSM-III changed that to an official mental illness of it's own, and homosexuality once again became "Ego-dystonic homosexuality", now downgraded to a neurosis not indicitive of mental illness. The DSM-III now contained 494 pages and 265 separate diagnostic categories. It brought about a revolution in psychiatry, and caused the beginning of "medical psychiatry". But we weren't done yet.

In 1987, the DSM-III-R was published, now up to 292 diagnosis in 567 pages. PMDD and Masochistic Personality Disorder were considered, but were too "normal" and thus discarded. Homosexuality became "sexual disorder not otherwise specified" which can contain "persistent and marked distress about one's sexual orientation" (gee, I thought that was supposed to be caused by religion). Fewere people yet considered normal- and psychiatry became big bisuness. But autism was still a 1:10,000 disorder at this time.

In 1994, autism got new attention in the DSM-IV. With 297 disorders and 886 pages, it was becoming quite the thick tome. Masochistic Personality Disorder was back- but now as Pervasive Development Disorder Not Otherwise Specified (PDD-NOS), a diagnosis familiar to many of us older high functioning autistics, for this was often our first label before being refined down as Asperger's Syndrome; based on some archeology done by Lorna Wing in 1981 and Uta Frith in 1991. Dr. Hans Asperger has originally written his paper in 1944, but was accused under the Nazi eugenics policies of the era as coddling his "little professors", his paper was not widely read outside of Germany at the time. Sure enough- soon afterwards we saw autism diagnosis take another leap forward, to the 1:1000 range.

In 2000, the DSM-IV-TR ("Text Revision") brought Asperger's and PDD-NOS officially under the umbrella of the Autism Spectrum- as well as ADD and ADHD, and sure enough we took another leap in the number of mentally ill- within three years "Autism Speaks" and other parental cure organizations would be formed, and due to the more specific diagnosis updated to maintain consistency with the international ICD-9 publication, autism would become a 1:100 disorder, with a full 1% of Americans diagnosed with it. The DSM-IV-TR has 365 diagnosis, and is more than 1000 pages long. The 200% increase in number of disorders since the DSM-I has been pushed for mainly by drug compainies, who wish to sell all sorts of snake-oil treatments fo DSM-IV-TR disorders. There's also a lot of co-morbidity involved, which indicates to me that we're well into the range of giving multiple diagnoses for the same set of behaviors. There also seems to be some prejudice and politics involved, as for instance elsewhere in the world homosexuality is still considered a mental illness, yet there's now a push for Oppositional Defiance Disorder to become a mental illness- exhibited primarily by toddlers and teenagers. Gee, who doesn't oppose authority figures at that time in a normal human life?

In 2013, the DSM-5 (they've dropped the Roman numeral in the latest drafts to be sent out over the APA's website) includes the deletion of several types of schizophrenia, so the ratio of psychoses to neruosis will change. But there is further anti-male and anti-intellectual bias as Asperger's Syndrome becomes HFA- High Functioning Autism- and ADD/ADHD/ODD give teachers a new way to segregate students they don't like and label them with autism.

My prediction- in 2013, autism will become a 1:50 mental illness due to this. And the "epidemic", caused by nothing more than further segregating human brains into little boxes, will continue, until the plutoarchs at the top keep the military regiments at the bottom behaving as nice little soldiers, drugged into normalcy so that they can never rebel.

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Oustside The Asylum by Ted Seeber is licensed under a Creative Commons Attribution-ShareAlike 3.0 United States License.
Based on a work at http://outsidetheaustisticasylum.blogspot.com.