Jun 14, 2022 - Health

The "psychiatrist's bible" is suddenly a surprise bestseller

Illustration of a book as Sigmund Freud smoking a cigar in a psychiatrist's chair.

Illustration: Aïda Amer/Axios

The dry bible of the psychiatry world — the Diagnostic and Statistical Manual of Mental Disorders, or DSM — has become a surprise bestseller amid surging popular interest in mental health.

Why it matters: A record shortage of mental health providers, combined with unprecedented demand for psychological support, has led to a surge in self-diagnosis, doctors say.

  • With so many sources of emotional stress — the pandemic, gun violence, urban crime, the war in Ukraine — everyone wants to know if their own difficult feelings could be signs of something bigger.
  • The number of people showing symptoms of anxiety and depression tripled during the COVID-19 pandemic, per the Centers for Disease Control and Prevention.

Driving the news: The American Psychiatric Association (APA) released a newly revised edition of its standard-setting manual, known as the DSM-5-TR, in March — the first update in nearly a decade.

"The public has been dying to know more about mental illness, and this book just happened to come out," Saul Levin, APA CEO and medical director, tells Axios.

  • "I think what really caught the imagination was that we're sitting at home now and looking to say, 'Boy, I'm feeling depressed — let me now go and find out more about it,'" Levin adds.
  • The DSM-5 also came up during the Johnny Depp-Amber Heard trial.

Yes, but: Doctors warn that laypeople shouldn't use the book to diagnose themselves.

  • The book's brisk sales may reflect "a frantic attempt to get some help somewhere, but it's not going to help people," says Robert Smith, an internist and professor of psychiatry at Michigan State University.
  • "The criteria in DSM, they are not easy to understand," Smith says. "In fact, primary care docs don't use them because they're difficult to understand."
  • Even within professional circles, the book causes big controversy about topics like which syndromes deserve recognition and how symptoms should be defined.
  • For example, the latest version identifies "prolonged grief disorder" as a new diagnosis — but not everyone agrees.

The big picture: Mental health therapy has gone mainstream. Younger workers are demanding it as an employee benefit, and athletes like Simone Biles, Naomi Osaka and Michael Phelps have openly described their struggles, prompting others to seek help.

But along with this attention comes controversy:

  • Issues addressed in the DSM — like care for transgender children — have been a a focus in society's culture wars.
  • While gun legislation in the Senate includes money for enhanced mental and behavioral health services — which most Americans welcome — the APA notes that "the overwhelming majority of people with mental illness are not violent."
  • Some young people seek out the "curious cachet" of a DSM-5 diagnosis and show disappointment when they can't get a label, Ralph Lewis, a Toronto-based psychiatrist, tells Axios.

Among younger millennials and Gen Z, "there does seem to be this almost clamoring, seeking out of psychiatric diagnosis and self-diagnosis — and a little bit of competition among their peers to acquire these diagnoses," Lewis said.

  • There's a growing tendency to over-diagnose and "medicalize" normal anxieties and run-of-the-mill neuroses, he writes in Psychology Today.

Between the lines: Medical professionals from all fields are taking a fresh interest in psychiatry and the DSM as more patients show signs of mental disturbance, psychiatrists say.

  • "I've had friends who are surgeons, internists, all of a sudden saying to me, 'So, I bought the book,'" Levin tells Axios.
  • "I'm hoping it's an inflection point, that the country has now realized that we have to do things differently" and make mental health a priority, he says.
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