Diagnosis

The more interesting question is who needs the DSM anyway? First of all, bureaucracies. Everyone in North America who hopes their health insurance will cover or at least defray the cost of treatment for their mental illness must first receive a diagnosis that fits the scheme and bears a numerical code.

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The first DSM (1952) and its successor, DSM-II (1968), were heavily influenced by the psychoanalysis then dominant in the United States. But with DSM-III in 1980 there was a new beginning. There were two notable causes, aside from the waning of psychodynamic therapy. First was the discovery of a genuinely effective drug for controlling mania... Second was a comparative study in 1972 of diagnoses of schizophrenia in London and New York. It was a rude comeuppance. Schizophrenia was diagnosed about twice as frequently in New York as in London. Symptoms were agreed on, but not the final diagnosis. ‘Operational’ criteria had to be fixed. Since we did not understand the causes of most mental illness – or rather there were too many incompatible theories of causation – we should rely on syndromes, on observable patterns of symptoms, behaviour in short, on which there could be some agreement. This approach is often called Kraepelinian, after the great German psychiatrist Emil Kraepelin...

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In Pharmaceutical Reason: Knowledge and Value in Global Psychiatry (2005) Andrew Lakoff writes about gene-hunting drug companies which want lots of spit and blood samples so they can try to match up a disease with DNA, devise a way to detect the malady through DNA markers and then find a new drug that will ameliorate the symptoms. Mental disorders have to be identifiable by means of the DSM, because the US is the biggest market for medications. Partly to avoid ethics committees, and partly to keep a global net in place, the gene-hunters often go to impoverished places. In one case, a French drug company wanted DNA from bipolar patients. There was an underfunded mental hospital in Argentina, but it was psychodynamic in practice. Bipolar disorder is Kraepelinian, not Freudian, and so the hospital had no patients diagnosed as bipolar. The drug company made an offer the hospital could not refuse. So it reclassified its patients to DSM standards; doctors rethought and the patients experienced the symptoms in new ways. Such are the mechanisms of cultural imperialism.

- "Lost in the Forest", Ian Hacking reviews the DSM-5 in the London Review of Books.

Retirement

The Australian government is currently spending about $32 billion per year on superannuation tax expenditures (taxation based incentives for superannuation contributions). It has been estimated, by the superannuation industry, that this $32 billion in tax expenditures is currently saving the government about $7 billion in pension costs. So, if we dumped all of the superannuation tax concessions, we could not only provide pensions to all of those who would become eligible but also increase payments to provide a more comfortable retirement.

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About 38 per cent of the superannuation tax expenditure goes to the wealthiest 10 per cent, which means that by 2014–15 the top 10 per cent of income earners will receive over $17 billion in tax concessions. So why exactly are we planning to spend $17 billion per year helping the wealthiest Australians save for their retirement?

- Warwick Smith at Overland.