When Doctors Define Health

Such arguments become deep precipitously, but there remains something disconcerting about the method by which society determines the behaviors that are considered within the bounds of normality and those that justify treatment:

The book is at least three years away from publication, but it is already stirring bitter debates over a new set of possible psychiatric disorders.

Is compulsive shopping a mental problem? Do children who continually recoil from sights and sounds suffer from sensory problems — or just need extra attention? Should a fetish be considered a mental disorder, as many now are?

Panels of psychiatrists are hashing out just such questions, and their answers — to be published in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — will have consequences for insurance reimbursement, research and individuals' psychological identity for years to come.

The process has become such a contentious social and scientific exercise that for the first time the book’s publisher, the American Psychiatric Association, has required its contributors to sign a nondisclosure agreement.

The debate is particularly intense because the manual is both a medical guidebook and a cultural institution. It helps doctors make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment.

The judgment of normality and disorder ultimately falls to the individual and to those who interact with him or her. The difficulty (and political jockeying) increases in proportion to the compulsory assistance of those whom consensus acknowledges as having problems — and compulsory acceptance of those whom "consensus" denies as having problems.

We are called, I believe, to help those who need help and to accept those whose challenges do not bear directly on our specific relationships with them. The current structure for psychological diagnoses, however, seems to be drifting toward ever more infringement on our own ability and right to judge those around us for ourselves.