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Why We're Turning Psychiatric Labels into Identities

So you’re on the spectrum, or you’ve got borderline personality disorder, or you’re a sociopath: once you’re sure that’s who you are, you’ve got a personal stake in a very creaky diagnostic system.

First produced by the American Psychiatric Association seven decades ago, and currently in its fifth edition, the DSM organizes conditions into families such as “anxiety disorders,” “sexual dysfunctions,” and “personality disorders.” Each diagnosis is described by clear criteria and accompanied by a menu of information, including prevalence, risk factors, and comorbidities. Although clinicians and researchers have understood the DSM to be a work in progress, many had faith that the manual’s categories would come to approximate natural kinds, exhibiting, as the Columbia psychiatry professor Jerrold Maxmen put it in 1985, “specific genetic patterns, characteristic responses to drugs, and similar biological features.” Steven Hyman, who directed the National Institute of Mental Health from 1996 to 2001, told the Times that he considered the manual an “absolute scientific nightmare.” In 2009, four leaders of the DSM-5 revision wrote about their hopes to “update our classification to recognize the most prominent syndromes that are actually present in nature.” The outcome didn’t live up to those aspirations.

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