Why are some people crazy

Really sick or normally crazy: where does crazy start?

What some dismiss as mood swings, others define as disorder. The number of diagnoses is growing. Insane, says a psychiatrist.

The number of psychiatric diagnoses is growing. And with it those of the people who take pills. Image: dpa

When the psychiatrist Allen Frances was younger, he once suggested adding a new classification to the catalog of psychiatric diseases: masochistic personality disorder. “It should be for people who do self-destructive things,” recalls the professor emeritus from Duke University in North Carolina, whom the New York Times calls the most influential psychiatrist in the United States.

When Frances was later responsible for the system that determines psychiatric disorders in the United States, and sets it down every few years in a psychiatry manual called the DSM, he said no. “Absolutely not,” says Frances. Such a masochistic disorder should not be included in it. It would harm people. Namely those who are wrongly labeled as sick.

The psychiatrist has now reached 70. And now that the fifth version of the Diagnostic and Statistical Manual of Mental Disorders, the bible of the psychiatrists' guild in the United States, is coming out, he is downright fighting it. Although he was still responsible for the previous version himself.

More dangerous than medication

"New diagnoses are more dangerous than new drugs," says Frances in the taz.am weekend. Because once they were in the world they would also be actively diagnosed. The number of people labeled as ill and those with stigma is growing. "Before a new diagnosis is introduced, it should actually be subjected to the same tests as new drugs."

The cover story "Where does the wrong start?", A photo reportage about the drug war in Mexico and a sonntaz dispute on the question "Does tax law create fraudsters?" read in the new taz. on the weekend of 11./12. May 2013. Also included: Three carrot recipes by Sarah Wiener. At the kiosk, eKiosk or even with a weekend subscription.

This new Handbook of Psychiatric Disorders will appear at the end of May. Psychiatrists all over the world, including Germany, have struggled for years to find out which new psychiatric diseases should be introduced into them (and how the old ones should be redefined). For example, it was about the question of whether a category like “psychosis risk” is needed. If they existed, teenagers could be given a label while they were still in school that would change their entire life.

Then there would be the boy whom you better be a little careful with. It could be that ...

Or the girl who, of course, is acting a little weird right now. You also know where that comes from.

Changed lives

Psychiatric diagnoses can change lives. And they can secure substantial profits for the pharmaceutical industry. Because their developers look through every additional manual very carefully to see which new disorder a drug would be suitable for.

The proponents of the psychiatry standard work not only see a danger in all the new disorders: The diagnosis key is also becoming finer, they say. And don't more detailed diagnoses help the patient?

Isn't it also the case that many people nowadays are really asking for a diagnosis? Even those who are not really mentally ill. We have the impression that something is wrong with us and would like to be able to name it. We look for a label for our problems, we google for diagnostic keys. We want that too. Or?

All nonsense? You should be happy when you're halfway well? After all, the imaginary mentally ill only block the places in the doctor's offices that the really depressed people need - as the psychiatrist Allen Frances criticizes? And isn't he right? Does this mania for diagnosis create way too many nonsensical treatments that nobody would need - that might even harm?

What do you mean? Discuss here on taz.de.

You can read the cover story “Where does it start?” In the new taz.am weekend from 11./12. May 2013.