Mental health diagnoses and the boundaries between them are like countries and their borders. I doubt this is an original analogy but it came in handy as I was talking with two people recently. Both have partners with mental health challenges. And both people, and their partners, struggle with the pathologizing of behaviour that happens in the DSM.
In talking with them, I was trying to help them understand how much formal diagnoses have both helped and hindered me. And because of the issues they were dealing with, I emphasized how much they have helped. I definitely feel more helped than hindered by the characterisation of my conditions. Pathologizing them is also sometimes, but not as often, helpful.
In one case we were discussing Aspergers Syndrome, which, after much deliberation and a formal process, technically no longer exists. But, like, Tibetans, Aspies will probably continue to forever identify themselves, meaningfully, and helpfully, as such.
What’s cool to me about the analogy is that it works so well. Yes, many of the borders between countries are artificial, and yet they definitely mean something: experiences are often quite different in one country versus another. And in the regions where borders intersect, sometimes the characters of two or more regions are shared. While we may change the borders and names of countries (and conditions), the characteristics of the underlying people reflect something that endures despite what name we give them. And changes to names or borders are usually the result of our changing understandings of what is happening within, and to, those regions. Perhaps most powerfully: whether and how we construct borders shapes what happens to the people within them.
I would even go so far as to say there is a topography to the borders between some mental health conditions: Bipolar Disorder and Schizophrenia definitely share a border. In some places the border is a sharp chasm of psychosis to be found after ascending a mountain and falling off the cliff of mania. In other places the border is a hostile region of unpredictable geography and fuzzy boundaries that has emerged as a diagnosis of its own: schizo-affective disorder.
My feelings about the DSM are on kin with my feelings about stereotypes. As reluctant as we might be to admit it, they both serve a purpose. The critical issues are: where do they come from, what do they communicate about the people they are purporting to characterise, and, how and why are we using them?