This is a very damning article. Everything said in this article is important to discuss, but I have my concerns.

Does this article make a person more or less likely to seek help from a mental health professional? Less likely.
Does this article reinforce a lay perception that MH pros are just a bunch of quacks? Yes.
Does this article increase the stigma for someone that seeks help from one of them? Yes.

I realize the author, and probably Slate‘s editors, share some of my concerns, and would argue that it is the APA itself that is creating these risks, and they’re just reporting it.

But as I read the first, second, third, fourth, fifth … paragraphs it feels as if Lane is driving nails into the coffin of something we shouldn’t kill.  Do you hear the nail splinter the pine box with each hammer strike?  I’d like him to be a little more relenting, create a little less collateral damage.

Ok, I’ve said my peace. Now the article in Lane’s own words.

The American Psychiatric Association has no clear definition of the cutoff between normal and pathological responses to life’s letdowns.

The association risks losing sight of that distinction by grimly—and rather inexpertly—debating whether avid shopping should be considered a sign of mental illness. The fifth edition of the association’s Diagnostic and Statistical Manual of Mental Disorders is expected in 2012. The APA isn’t just deciding the fate of shopaholics; it’s also debating whether overuse of the Internet, “excessive” sexual activity, apathy, and even prolonged bitterness should be viewed, quite seriously, as brain “disorders.”

Allen Frances chaired the DSM-IV task force. Robert Spitzer editted DSM-III and -IV.

After Frances made his objections public last month, he and Spitzer followed up by sending the APA an open letter: “Unless you quickly improve the internal APA DSM-V review process, there will inevitably be increasing criticism from the outside. Such public controversy will raise questions regarding the legitimacy of the APA’s continued role in producing subsequent DSMs—a result we would all like to avoid.”

Spitzer and Frances also strongly disagree with a proposal to include “subthreshold” and “premorbid” diagnoses in the new manual. Both terms give cover to the so-called “kindling” theory of mental illness in children and infants—some psychiatrists believe that it’s possible to stamp out ailments before they burgeon into full-blown disorders.

This idea of kindling relates to my post yesterday on catching schizophrenia during prodrome before it turns psychotic.

In practice, as the St. Petersburg Times reported in March, psychiatrists in Florida alone gave antipsychotic drugs off-label (without formal FDA approval) in 2007 to 23 infants who were less than 1 year old at the time. They extended the practice to 39 toddlers aged 1; 103 aged 2; 315 aged 3; 886 aged 4; and 1,801 aged 5. One shudders to think what is going on in other states.

If you’re still reading down here at the bottom of the post, you may be wondering what is the DSM for. Here is wikipedia:

Many mental health professionals use this book to determine and help communicate a patient’s diagnosis after an evaluation; hospitals, clinics, and insurance companies also generally require a ‘five axis’ DSM diagnosis of all the patients treated. The DSM can be used to establish a diagnosis or categorize patients using diagnostic criteria. The DSM may also be used in mental health research. Studies done on specific diseases often recruit patients whose symptoms match the criteria listed in the DSM for that disease.

The wrong coding in the DSM may excuse your insurance company from paying.