Considering the economy of DSM alternatives

Abstract

Criticisms of the DSMs over the past 30 years have rarely generated credible alternative classifications of psychopathology, and virtually all rivals have fallen away, as judged by clinical or research impact. This chapter considers why this has been the case. After some historical context-setting, I propose and defend the following thesis: The DSM prevails because it is, by historical default, entrapped within a “mental health medical-industrial complex (MHMIC)” in which alternatives are economically locked out. The MHMIC as described here consists of ten elements which converge fiscal interests and constrain mental health funding with respect to those interests. This constraint tends to lock the description of psychopathology into a preserve-the-status-quo stance described by Frances and Pincus in the DSM-IV era. The support for this thesis will be graphically displayed through a portrayal of vectors of financial interest involving these stakeholders. The subjugation of scientific, conceptual, or humanistic interests to economic interests is the result, and DSM “pragmatism” will be redescribed as a literal economy of means.