The future of the DSM continues to be heavily contested in the field of mental health. The term “mental illness” has long been linked to conditions outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). However, as our comprehension of mental health and well-being advances, it is essential to examine the concept of healing and recovery for individuals with stable mental health or well-managed mental health disorders.
Defining mental illness
The DSM is widely recognised as the authoritative guide for diagnosing mental disorders. It categorises various conditions, outlines diagnostic criteria, and aids clinicians in identifying and treating mental health issues. The work on DSM-5 began in 2000; work groups were formed to create a research agenda for the fifth major revision of DSM (DSM–5). DSM-5-TR was published in March 2022. However, it’s important to remember that the DSM provides a snapshot of mental health at a particular point in time and may not capture the dynamic nature of mental well-being.
The spectrum of mental health
One way to approach this question is to acknowledge the mental health spectrum. Mental health is not binary; it exists on a continuum. Some individuals may have experienced mental health challenges in the past but have since achieved stability through therapy, medication, and personal growth. Others may have never experienced a severe mental health crisis but still benefit from therapeutic interventions.
For example, consider an individual diagnosed with generalised anxiety disorder (GAD) who, after receiving therapy and developing coping strategies, now experiences minimal anxiety and can function effectively in their daily life. Does this individual still fall under the category of “mentally ill” as defined by the DSM? The answer is not clear-cut.
Acute vs chronic mental health conditions
- Acute conditions. These are mental health conditions that are typically of short duration and often have a sudden onset. They are characterised by intense symptoms that may require immediate intervention. For example, a person experiencing a severe panic attack for the first time would be considered to have an acute anxiety episode.
- Chronic conditions. In contrast, chronic mental health conditions are persistent and long-lasting. They may have a gradual onset and are often associated with enduring symptoms. Conditions like schizophrenia, bipolar disorder, or personality disorders are examples of chronic mental health conditions.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) includes specifiers that further describe the course and severity of mental health conditions. These specifiers provide clinicians with additional information about the nature of the disorder, its current status, and its response to treatment. Two relevant specifiers in the context of our discussion are:
- Partial remission. This specifier is used when a person’s symptoms have improved significantly but do not meet the full criteria for remission. It indicates that the condition is still present, but the individual is experiencing a substantial reduction in symptoms and is functioning better than during the acute phase.
- Full remission. When a person’s symptoms have significantly improved to the point where they no longer meet the diagnostic criteria for the disorder, they are considered to be in complete remission. This does not necessarily mean that all symptoms have completely disappeared, but they are no longer severe enough to warrant a diagnosis.
Implications from a clinician perspective
- Understanding the fluid nature of mental health. Specifiers like “in remission” highlight the dynamic nature of mental health conditions. Clinicians must recognise that individuals can move from acute to chronic and from active symptoms to remission. This understanding helps clinicians avoid stigmatising individuals who may have experienced severe symptoms but have made significant progress in their recovery.
- Tailoring treatment approaches. The presence of specifiers can guide clinicians in tailoring treatment approaches. For individuals in acute phases, the focus may be on crisis management and stabilisation. In contrast, for those in remission, the emphasis might shift towards maintaining stability, preventing relapse, and enhancing overall well-being.
- Destigmatizing the idea of remission. The concept of remission should not be seen as the endpoint of treatment but rather as a phase within the ongoing journey of mental health. Clinicians can play a crucial role in reducing the stigma associated with mental health conditions by emphasising that remission is a positive and achievable outcome. This encourages individuals to seek help and adhere to treatment plans.
- Recognising the potential for recovery. The presence of specifiers like “in remission” underscores the potential for recovery in individuals with mental health conditions, even chronic ones. Clinicians should maintain an optimistic and recovery-oriented perspective, acknowledging that individuals can lead fulfilling lives despite having experienced significant mental health challenges.
Healing and recovery
Healing and recovery are essential aspects of mental health. For many individuals, managing their mental health disorder effectively allows them to lead fulfilling lives, maintain relationships, and pursue their goals. It’s crucial to emphasise that healing and recovery do not necessarily mean the complete absence of symptoms but rather the ability to manage and cope effectively.
Research has shown that individuals with well-managed mental health conditions can achieve levels of well-being comparable to those without diagnosed disorders. This challenges the notion that once diagnosed, a person is forever marked as “mentally ill”.
Society and the mental health field need to reconsider our perspectives on mental illness. Shifting from a strictly diagnostic approach to one that emphasises healing and recovery can reduce stigma and empower individuals to seek help without fear of being labelled as permanently “ill”.
For example, there has recently been a growing movement towards “person-first” language in mental health discussions. Instead of saying “a schizophrenic”, it’s more respectful and accurate to say “an individual with schizophrenia.” This subtle shift acknowledges the person’s humanity beyond their diagnosis and recognises their potential for growth and recovery.
While the DSM serves as a valuable tool for clinicians, it’s essential to recognise that mental health is a dynamic and evolving aspect of a person’s life. Healing and recovery are possible, and individuals who have achieved stability in their mental health should not necessarily be defined solely by their past diagnoses.
By embracing a more holistic view of mental health, we can better support individuals on their journey towards well-being and truly understand what it means to heal and recover from mental health challenges. This shift in perspective can lead to more compassionate and effective mental health care, reducing the stigma associated with mental illness and ultimately improving the lives of countless individuals.
Maxwell E. Guttman, LCSW is a psychotherapist and owner of Recovery Now, a mental health private practice in New York City.