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Saturday, June 8, 2013

Blurring the distinctions between normal variation and disease

The newly released DSM 5 has created another round of controversy. Over the years, the DSM has grown in size and complexity and the latest version, with almost 950 pages. This latest version has been accompanied by issues of inadequate validity studies, even prompting the NIMH to work on its own study. In his book "Saving Normal", Dr. Allen Frances explains that a crux of the problem is that it is impossible to define normal or mental disorder.

This problem is not exclusive to psychiatry. In a world where we are tempted to medicalize everything, any variation ends up becoming some variant of pathology. What is normal and what is disease? This ends up having huge ramifications. If every undesirable human state is redefined as some variant of human disease, than everything becomes part of health care.

Are you shorter than you desire? That is verticality deficiency disorder which can be addressed. Are you emotionally disturbed by your body habitus? Might you want improved muscle tone or exercise tolerance? Difficulty with concentration or attention span? Peculiar pigmentation? Disturbed by the effects of aging on your appearance? All these states may be amenable to medical intervention.

In a world where we use our individual resources to address these issues, we make decisions as to our own priorities. However, it the brave new world where resources are commonized first and then allocated by all knowing central bureaucracies, the legally mandated one size fits all of entitlements forces us to decide what is normal and what is sufficiently pathological to warrant interventions. It is an impossible task.

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