Dr. James Davies interviewed the leaders of the DSM committee and conducted archival research on the process of creating the controversial edition. What he discovered was troubling: most diagnoses were not based on biological findings or solid scientific research but rather on consensus and votes by a small group of psychiatrists. The definitions of disorders, symptoms, and diagnostic thresholds were determined through negotiation rather than empirically.

The dynamics in the committee meetings were influenced by the most dominant personalities, not necessarily by medical considerations. Decisions were sometimes made arbitrarily, as in the case of the debate over including “Self-Defeating Personality Disorder” despite strong opposition arguing that it could pathologize women who were victims of violence. The consequences of DSM-III were far-reaching, as it became a standard that fundamentally changed psychiatric research and practice worldwide.

Even the chairman of DSM-IV, Professor Allen Frances, later admitted that the inclusion of certain disorders like Bipolar II or Asperger’s syndrome led to “false epidemics” and mass over-diagnosis. However, he claimed that at the time, it was important to stabilize the system and avoid further arbitrary changes.

Today, there is a worrying trend of a massive increase in the number of people receiving psychiatric medications. In England, over 20% of the adult population received such a prescription in the past year, nearly double the rate from 15 years ago. Additionally, the average duration of antidepressant use has doubled over the past decade. These trends are concerning given the risks and side effects associated with long-term medication use. It appears that excessive medicalization processes, which encouraged the expansion of mental illness definitions, also served the economic interests of psychiatric pharmaceutical companies.

These findings challenge the conventional perception of mental disorders as distinct biological pathological states. It turns out that most psychiatric diagnoses are not objective scientific facts but reflect the socio-cultural constructs of a particular group of professionals at a given time. It is time for a rethinking and public discussion of these issues, striving for a more humane and complex approach to understanding human mental distress.

**The Rapid Expansion of the Psychiatric Diagnostic Manual**

In recent decades, modern psychiatry has increasingly tended to classify a wide range of normal human experiences, even those that are sometimes painful and complex, as pathological conditions requiring pharmaceutical intervention. At the heart of this troubling trend is the famous Diagnostic and Statistical Manual of Mental Disorders (DSM), which has undergone a staggering expansion at a faster rate than any other medical guide. The publication of DSM-III in 1980 marked a dramatic turning point, with the inclusion of 80 new mental disorders and a significant lowering of the threshold for defining certain behaviors or feelings as disorders requiring treatment. This marked a fundamental shift that has impacted not only psychiatry but culture as a whole.

Participant testimonies from the discussions described a less-than-professional atmosphere, where the influence of dominant personalities often overshadowed substantive arguments. Dr. Spitzer himself was known for making decisions quickly, sometimes without a solid foundation. In one instance, he even drafted the criteria for two new disorders on the spot during a few minutes of conversation with a handful of psychiatrists. Additionally, there were cases where decisions to include or exclude diagnoses were made based on entirely arbitrary considerations. A representative example is the debate over “Self-Defeating Personality Disorder” (SDPD). Despite the convincing arguments of Dr. Paula Caplan, who warned that this diagnosis could stigmatize and blame women who had experienced violence, the committee members chose to stick to their position and include it in the manual without addressing the concerns raised.

When DSM-III was published, it quickly became a global sensation. It sold in massive quantities, not only to psychiatrists but also to a wide range of therapeutic and other professionals. Beyond that, the manual began to reshape the discourse on mental health worldwide. The DSM’s diagnostic concepts became widely accepted, largely dictating the research, treatment, and experience of mental distress. However, despite this massive impact, the general public, and even most users of the manual, were largely unaware that the majority of the diagnoses were not based on solid science but rather on the opinions and decisions of a small group of psychiatrists. As Dr. Spitzer candidly stated in an interview with Davies, “It was a revolution. We took over because we had the power.”

Dr. Allen Frances, who succeeded Spitzer as the chair of the DSM-IV committee, later acknowledged the problematic nature of some of the decisions that were made. He admitted that new diagnoses added, such as “Bipolar II Disorder” or “Asperger’s Disorder,” led to “false epidemics” of mass over-diagnosis. Nevertheless, Frances still believed that, at that point in time, it was important to “stabilize the system” and avoid further changes that could also have been arbitrary. He also did not address the serious issues that had already been entrenched in previous editions and which he allowed to persist.

In light of all the above, it is clear that a radical rethinking is needed in how we understand and respond to human mental distress. There is a need for an approach that is less focused on defined diagnoses and medications and more on embracing the complexity of human experience and its social and cultural contexts. We must demand and engage in a meaningful public discussion on the fundamental issues raised, involving a diverse range of voices, especially those who have experienced or are experiencing mental distress. The goal should be to build a more humane, less pathologizing, and more open approach that recognizes that human beings are not simply a collection of symptoms to be fixed, but complex creatures who face challenges and need compassionate and understanding support. Only in this way can we promote a healthier and more supportive society concerning mental health.

1. Be aware that not all emotional distress necessarily indicates a psychiatric disorder requiring medication.

2. Do not accept psychiatric diagnoses as absolute scientific facts, as many of them are based on consensus rather than biological evidence.

3. Carefully weigh the benefits against the risks before taking psychiatric medications, especially for long-term use.

4. Demand complete information about the scientific evidence (or lack thereof) supporting your psychiatric diagnosis.

5. Don’t hesitate to ask for non-pharmaceutical treatment alternatives, such as psychological therapy or social interventions.

6. Be an informed consumer and do not let pharmaceutical company marketing unduly influence your treatment decisions.