2026-02-06
DSM-5 is broken
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- See also: Therapy effectiveness (personal)
- The other post talks about why the median therapist couldn't help me with certain specific issues I had. I was open to the idea that therapists are useful for others, and that the right therapist may still be useful for me.
- With this post, I will make a much stronger claim. I think DSM-5 is close to useless for most people facing most issues under most psychologists. I want this post to be about DSM-5 in general rather than what helped me in particular.
- In short, DSM-5 seems to mainly mark a boundary between mild and extreme versions of many mental health issues, by providing some heuristics to identify where exactly the boundary lies. These heuristics often basically boil down to a) do you have a job? b) do you have a non-empty social circle? c) if the answer to either is no, is this specific mental health issue the reason?
- I personally paid most attention to the sections on autism, substance use and ptsd. But I think this trend is true across many other mental health issues.
- My biggest problem with defining such a boundary is - what is this boundary actually useful for?
- Ultimately the person who needs help cares about advice and emotional support.
- DSM-5 is obviously not meant to provide emotional support to anyone.
- DSM-5 does contain some advice for the client.
- DSM-5 does not have good advice for most people dealing with mild versions of most disorders IMO.
- Maybe DSM-5 does have useful advice for atleast some people dealing with strong versions of these disorders. But even that is less clear.
- I don't see how defining a boundary makes the advice more useful. Like, if the authors knew that some advice only worked well past some threshold, then it is worthwhile to specify what that threshold is. But most advice I see doesn't seem to be the type that kicks it at a specific threshold.
- In particular, I don't see why "do you have job?" and "do you have people?" are the universally correct thresholds for accepting advice. It is true that if a mental health issue caused you to lose your job, you should probably put more effort into trying to fix it. But it is not clear why the advice you receive will only work if you lose your job, but not before.
- DSM-5 seems mainly used by the US legal system, to decide who gets healthcare insurance (lol) and who gets to be involuntarily hospitalised.
- "do you have job?" and "do you have social circle?" make more sense if the goal is to maintain either law and order, or the US govt's continued existence. People with a job and social circle are less likely to commit crimes. People with a job and social circle are also less likely to acquire actual billionaire/politician-level power, or become a crazy political activist (like me lol) or similar.
- (I am aware that some therapists explicitly target unusual niches like women or founders or activists or whatever. I am talking about the DSM-5.)
- I don't want to go so far as to claim that the heads of APA are directly talking to the heads of NSA or ICE or similar to planning this together, because I don't actually know if that is true.
- I do think there's high likelihood of implicit collusion though. I mean the NSA and the APA might act in coordinated way without talking to each other, and there might be pressure in terms of access to funding or networks. I might (or might not) investigate this more in future.
- I haven't read about DSM-5 criticisms a lot, but I am aware many people have made similar criticisms as me.
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