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Without a biological basis, how reliably can we diagnose and treat mental illness?

The DSM — "psychiatry's bible" —has long been the subject of controversy.
The DSM — "psychiatry's bible" —has long been the subject of controversy.

We have MRIs for the brain and spinal cord, and EKGs for the heart. But when it comes to pinpointing depression or anxiety, the tools for precision are limited.

That’s why for the last 70 years, “psychiatry’s bible” has been the “Diagnostic and Statistical Manual of Mental Disorders (DSM).”

It’s a collection of criteria for psychiatric illnesses that’s updated periodically. But it’s long been the subject of controversy — from its ties to the pharmaceutical industry to concerns about overdiagnosis.

In her new book, “Pathological: The True Story of Six Misdiagnoses,” author Sarah Fay chronicles her uphill battle to find a reliable diagnosis.

I believed in and accepted those six diagnoses — adopted them, thought in terms of them, identified myself as them, medicalizing my difficulties and discomforts, pathologizing my emotions and thoughts and behaviors.

Embracing a diagnosis can be a good thing. It can increase the likelihood that a person will get help. It can lead someone to find a community of people who suffer from the same diagnosis. It can empower a person.

But it led me into a spiral. Each diagnosis was a self-fulfilling prophecy. The sicker I believed myself to be, the more evidence I found confirming I was sick. The more evidence I had, the more certain I became. The more certain I became, the more willing I was to undergo treatments. The more treatments I underwent, the sicker I believed myself to be. It’s too easy to lay blame, but I do. I blame the book: the Diagnostic and Statistical Manual of Mental Disorders (DSM).

We talk with Fay and a panel of experts about how we diagnose mental health.

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