Fashions in the psychiatric diagnosis have recently become almost as fickle as the popularity of rock stars, trendy restaurants, and travel destinations. Because there are no biological tests or clear definitions that distinguish normal from mental disorder, everything in psychiatric diagnosis depends on very easily influenced subjective judgments. Whenever rates of a mental disorder jump explosively, the safe bet is always on fad. Assume that many, if not most, of the newly identified "patients" are really "normal enough." They have been mislabeled and will likely be over treated.
Psychiatric fads start when a powerful authority gives them force and legitimacy. The DSM system, and the "experts" who fashioned it, have been the main fashion setters -- the driving force in identifying new mental disorders and defining milder forms of those that had been previously described. Unfortunately most experts suffer from an intellectual conflict that biases them toward diagnostic inflation. Focused on their specialized research, they miss the big picture -- always worrying so much about not having a diagnosis for a patient who needs one that they ignore the risk of mislabeling someone who doesn't. There is also an emotional element. Experts become true believers who really come to love their pet diagnoses and want to see them grow. While each one presses for only a small expansion, their aggregate pressure blows up the inflationary balloon. In my thirty-five years of herding experts, not once has anyone every suggested raising the bar to narrow the scope of his pet area.
Allen Frances, M.D, "Saving Normal," pp.28-29
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