Social Environment Especially Important Now

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With recent events such as the bombings that occurred at the Boston Marathon shake the foundation of safety we might have felt in our society, the connection between mental health and social issues would seem obvious.  In addition to this type of tragedy, we are all dealing with the effects of an economic crisis that began almost five years ago.  It would appear impossible to accurately assess and diagnose an individual without taking an account of these kinds of influences.

However, according to recent research, the task force that developed the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) has moved away from incorporating these social influences into the diagnosing process.  The new edition of the DSM is set to be released next month, and has already undergone quite a bit of scrutiny.  The most recent of which has been from a twelve member research group headed up by Helena Hansen, MD, PhD, of New York University.  This team suggests employing an independent research group to review any future changes to the DSM, and noted, “Mental health leaders — including those revising the DSM — should go a step further and understand how social and institutional processes shape both the epidemiological distribution of disorders in the population and the way that disorders are identified and labeled.”  One example the team described was the possibility that people might seek a particular diagnosis in order to get disability benefits approved.  This would be an instance where the overall state of the economy could be influential in considering a diagnosis.  They also pointed to the social influence of pharmaceutical companies in the way that advertising the cure to a disease often involves first educating the public about the disease.  This identification and education about a diagnosis, restless leg syndrome for example, thus, undoubtedly affects the rate at which a particular disorder would be diagnosed.

The fourth axis of the five axis diagnostic system exists to encompass the social aspect of the individual.  Hansen’s team seems to be suggesting an increase in the overall consideration of the social influence on diagnosing.  As we move toward more of a biological basis for disease, it looks as if the focus of the upcoming DSM-V has shifted significantly away from considerations of social environment.  With our increased ability to use brain scans and the discovery of genetic markers, we are in danger of ignoring the ever important impact of society on the individual.

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