The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), published by the American Psychiatric Association in 1994, is well known as the standard reference for mental health professionals. What is less well known is that very many copies have been bought by lay people searching for knowledge and understanding of their own and their friends’ mental health problems. Am I Okay? aims to meet the demands of this important market by providing an accurate and faithful translation of that the DSM-IV into terms that can be understood by the lay person. The authors, being the chairperson and the editor of the DSM-IV, are obviously well qualified to perform such a task. The challenge facing them was not only to explain what the mental disorders were and how to diagnose them, but also to avoid over- and under-diagnosis, and to provide a guide that is positive and reassuring about a subject that can be very distressing and frightening to sufferers and their friends and families.

The book consists of an introduction, an overview of the categories of disorders, and twenty chapters, each dealing with a particular set of disorders; e.g. anxiety, abnormal eating, or personality disorders. There is also a final chapter which answers ten commonly asked questions, such as “What is causing my psychiatric problem?” and “What can I do to get better?” The individual chapters on particular disorders each contain some background information on the disorder, a set of diagnosis criteria for each type of disorder within the category, an explanation of how to distinguish this particular disorder from other disorders and from normal behavior, a discussion of treatment options, a short bibliography, and names and addresses of support groups and sources of information.

The temptation to over-diagnose is a potential problem in any book written for a lay readership. In order to avoid this, the authors often point out that a disorder can be viewed as an exaggerated or distorted version of adaptive behavior. For example, the ability to feel fear and avoid dangerous situations is essential for people to survive. Binge eating was necessary for our ancestors to take advantage of an unexpected feast when the supply of food was erratic. This means that if you can sometimes recognize in yourself mild versions of some of the indications of mental disorders, then you are probably experiencing emotions and behavior that are normal, and sometimes even beneficial. In contrast, it is emphasized that in order to make a clinical diagnosis, the suspected disorder must be severely impairing your life.

The authors also point out that certain disorders have recently become fashionable and that therefore care must be taken not to wrongly diagnose these. A notable example is that of Dissociative Identity Disorder (DID), formerly called Multiple Personality Disorder. The authors describe the recent increase in the diagnosis of multiple personalities as a kind of social contagion, caused by suggestible clients and therapists convincing themselves and each other that they have this disorder, which has been portrayed in the media as being a fascinating and exciting conditioning. Conversely, it has been argued that DID has been missed by clinicians in the past, but is now being recognized because of its high profile. I am inclined to believe the authors’ verdict that “any condition that has become a favorite with Hollywood, Oprah, and checkout-counter newspapers and magazines stands a great chance of being wildly overdiagnosed” (p. 288).

Under-diagnosis is also dealt with, most notably in the chapter on substance abuse: “If you have a substance problem, you will probably be the last to know it and the first to deny it even when confronted with the most compelling evidence” (p. 117). Whether the lengthy explanation of denial that follows this statement will convince the person that he does indeed have a problem I do not know, but at least it serves to reassure any of his relatives who are reading the book that his denial is to be expected and is part of the problem.

There is a great deal of information to digest in Am I Okay?, but the book is well structured and the style is clear and accessible without being simplistic. The book also contains some welcome humor and the occasional personal touch. In the substance abuse chapter I read, “One of the authors, for example, has a stubborn inability to resist the short-term pleasures derived from chocolate bars, despite a strong conscious desire to do so for the sake of his arteries…. The author is suitably humble about his own limited powers of impulse control” (p.118). Was it “the other author” who wrote that after winning a bet with his co-author, I wonder?

The DSM-IV has been criticized for having poor validity and reliability, particularly in regard to the personality disorders. Certainly a lay person’s version of the DSM-IV cannot hope to improve on the original in these respects. However, the patient who reads and assimilates the information provided in Am I Okay? will have the advantage of understanding the assumptions made by the clinicians who are treating him. He will know what the possible treatment options are, and what they require of him, giving him the chance to take an intelligent involvement in his treatment. “Knowledge is still power,” the authors say (p. 11). “You are more likely to get good care if you are educated about your problem, understand its usual course, and know what can be done about it. The more you learn the less alone you will feel, the less helpless, and the less uniquely damned.”

Natalie Simpson is a mathematics graduate of Oxford University, England, and holds a diploma in hypnotherapy. She developed an interest in psychology, psychotherapy and hypnosis after experiencing hypnotherapy herself. Her specific concerns include the assessment of the effectiveness and risks of psychotherapy, and the difficulties of obtaining informed consent of clients.

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Categories: MentalHealth, General

Keywords: Diagnosis, Differential, therapeutics