GENERAL COURSE DESCRIPTION This course critically reviews the professional, political, economic and sociological forces that operated in the development, utilization, marketing and selling of the DSM. The DSM has been called the (billing) bible of psychiatry and has been one of the most influential texts in the field of psychiatry, psychology, counseling and psychotherapy. Its influence has been much larger than in the field of mental health, as it has contributed towards our entire cultural attitude of what is healthy or unhealthy and what is normal or pathological. Most importantly, it shapes our attitudes of what constitutes proper treatment and healing. The DSM informs our entire culture of what is normal and what is not and guides us as to who should be allowed to remain free and who should be locked up. Diagnosis of physical problems has often been extremely useful, and in principle, psychiatric diagnosis can be helpful too. Unfortunately, psychiatric and mental health labeling have been conceived of and applied in extremely biased ways and is surprisingly unwarranted by scientific research. Thus it can result in harm to clients in general and specifically to minority, women, children and other marginalized groups. Because most undergraduate, graduate and postgraduate courses uncritically present the DSM as a scientific document, this course focuses exclusively on the rarely acknowledged critical view. This course was partly inspired by Dr. Paula Caplan's 1995 book They Say You're Crazy: How the World's Most Powerful Psychiatrists Decide Who's Normal and her 2004 book co-edited with Lisa Cosgrove Bias in Psychiatric Diagnosis. (Intermediate level). This course focuses on a critique of the DSM and examines concerns such as: The DSM is more a political document than a scientific one. Decisions regarding inclusion or exclusion of disorders are made by majority vote (such as the 1974 vote to eliminate homosexuality as a mental disorder) rather than by indisputable scientific data. The DSM gives the illusion that mental illness is a clearly identifiable brain disease. Unlike diseases such as coronary heart or cancer or medical conditions such as broken bones, there are no blood tests, X-Rays or brain imaging techniques to identify the presence of any of the DSM diagnostic categories. Each diagnostic criteria in the DSM is of an ever changing list of symptoms compiled by "experts". It is not based on medical science, blood or other biological tests. The rational seems to be: If you can describe a set of symptoms, then you can name a disease; and if you can name the disease, then you can claim it exists as a distinct "entity" with, eventually, a specific treatment tied to it. Diagnosis of "mental illness" is more an art than a science. DSM based research has repeatedly shown very poor reliability and, therefore, questionable validity. The DSM perpetuates the myth that the medical-mechanistic model can simply be applied to psychology and that by precisely identifying and naming the problem, treatment and cure will follow. The DSM tends to pathologize normal behaviors. Existential anxieties, for example, are labeled "Anxiety Disorder". As a result, some kinds of normal and rather healthy anxieties are viewed and treated as mental illness. Similarly, shyness can too easily be seen and treated as "Social Phobia", lasting grief as "Complicated Grief Reaction" or spirited and strong willed children as "Oppositional Disorder". Consequently, many psychotherapists, regardless of their theoretical orientations, tend to follow the DSM as it is in their professional best interest. The DSM, in the last three decades, has been primarily driven and controlled by psychiatrists and the psychopharmacological industry. Both groups have direct financial interest in focusing on individual pathology (rather than familial or societal), inevitably leading to medication-based solutions. The DSM focuses almost exclusively on individual pathology to the dangerous minimization of social factors such as poverty, racism, sexism, classism, ageism, violence, stress, etc. This limiting focus has serious ramifications, as therapists, who uncritically follow the DSM medical model, are likely to place undue emphasis on individual emotional problems as causal factors rather than opening to the larger possibility that the individual is symptomatic due to familial, political or societal system dysfunctions. Drug companies fund a significant amount of research that is used to advocate new DSM diagnostic categories. The DSM tends to pathologize attributes that have been associated with women, lower class, spirited children and geriatric populations. The first article, The Power of DSM-IV: Diagnosing for Dollars, gives an historical overview of the professional, economic and political forces that have shaped the different editions of the DSM. The second article, Is it Really Necessary, articulates the essence of psychiatric labeling and reviews the critique of the DSM as articulated in the 2004 Caplan and Cosgrove (Eds) book Biased in Psychiatric Diagnosis. The third article, Ethical Diagnosis: Teaching Strategies for Gender and Cultural Sensitivity, reviews the history of DSM from it early days when it was influenced by psychoanalysts to the present day, when it is influenced by biological psychiatrists, discusses several sources of bias in diagnosis and proposes responsible ways to teach the DSM. The forth article, Some Unarticulated Premises in the Rhetorical Construction of DSM Categories, discusses the mechanistic, scientific influence of the DSM and critiques what it calls the "halo of scientism." The fifth article, Premenstrual Mental Illness. The Truth About Sarafam, exposes how financial motivation shapes the course of psychiatric diagnosis. The last article, Diagnosing for Money and Power, summarizes all the concerns with the DSM and provides a short bibliography of books that are most relevant to the material presented in this course.