ROBERT SIEGEL, HOST:
This weekend, 20 people from around the country will meet in a nondescript hotel room in Arlington, Virginia and they'll take a vote. A passing stranger who looked in wouldn't see much - just a bunch of graying academic types at a table. But millions of people will be touched by what they do. That's because they're voting to approve the new diagnostic and statistical manual, the DSM-5. It's the bible of the mental health profession and it defines all official mental disorders. Every 10 to 15 years, a new one comes out and NPR's Alix Spiegel has the story of this fifth edition.
ALIX SPIEGEL, BYLINE: One of the graying academic types due to sit at the table this weekend is a tall, elegant man named Roger Peele, a longtime member of the American Psychiatric Association.
ROGER PEELE: I'm secretary of the APA, so I'm on the board.
SPIEGEL: OK. So, you're one of those people who's going to be voting?
SPIEGEL: Peele has been in the DSM business for a long time. He's worked on every DSM since 1975. So, Peele knows well just how influential the DSM actually is.
PEELE: It is used in the courts. It is used in the schools. It defines what we will call a mental disorder.
SPIEGEL: And in defining what we call a mental disorder, the DSM helps determine many, many other things. For instance, how struggling children are treated in school. If the disruptive behavior of a child is seen as a disorder - ADHD, autism - schools will help with subsidized services. If not, schools often see the child as just trouble. So it's no surprise that there's lots of controversy every time the DSM is revised - people arguing that the new definitions are too narrow or too broad, and the DSM-5 was no exception.
PEELE: I think DSM-5 has had more controversy - much more in terms of media attention.
SPIEGEL: So, what in the end is actually in? The APA won't give specifics but some of the changes that have been proposed are likely. Asperger's Syndrome is very likely to be eliminated. Instead of being diagnosed with Asperger's, people with mild autism are going to be categorized as autistic but mildly autistic - there's going to be a spectrum. Which, Peele says, upsets many people with Asperger's.
PEELE: People with Asperger's preferred that identity, as opposed to being seen as part of autism spectrum. I think that's been part of the complaint.
SPIEGEL: Many Asperger's patients see autism as a label signaling severe disability. The new DSM will also likely create a new disorder for children called Disruptive Mood Dysregulation Disorder. Many psychiatrists believe that too many children are diagnosed as having bipolar disorder and given anti-psychotic drugs and they want this new diagnosis to be used instead of bipolar for kids, so hopefully psychiatrists will reduce their prescriptions. Then there's the issue of how to think about bereavement. Dr. Sidney Zisook says in the last DSM, psychiatrists were told not to diagnose major depression in people who'd recently lost someone they loved, because grief after death is normal.
SIDNEY ZISOOK: That's reasonable thinking and certainly no one wants to pathologize grief or sadness or call it an illness when it is an absolutely normal human experience.
SPIEGEL: But Zisook argued, probably successfully, to change that. He believes many clinically depressed people were being ignored.
ZISOOK: It excludes a bereaved person from being diagnosed with depression if they have a depression, and no one wants to do that, either.
SPIEGEL: Now, this is a small change, but to critics, it's emblematic of a much larger problem, the expansion of behaviors considered abnormal. Shyness becomes social phobia, restlessness ADHD. Chris Lane is a DSM critic who worries the new DSM will label people sick even when they are not.
CHRIS LANE: I'm very concerned about the number of false positives that are likely to come from this new edition. That is, people who are overdiagnosed.
SPIEGEL: Roger Peele of the APA board obviously doesn't agree with Lane, which doesn't mean that he thinks the DSM-5 is infallible. Do you have a wish for this DSM?
PEELE: That people not see it as a bible, that they respect it but don't worship it.
SPIEGEL: Because, Peele says, while hundreds of researchers have worked hard to make the DSM-5 as good as they could figure, in the end, these are just their best guesses about how to define and think about mental disorders. Alix Spiegel, NPR News, Washington.
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