hey there. yes, what you are saying makes a lot of sense :-)

who decides what conditions count as mental disorders? at the end of the day... the American Psychiatric Association decides whether a condition will be listed in the Diagnostic and Statistical Manual of Mental Disorders or not.

E.g., 'homosexuality'. Used to be in there. Not in there anymore. 'pre-menstrual dysphoric disorder'. Not in there. Currently being investigated, however, might get to be in the next edition.

there is a lot of pressure on the American Psychiatric Association with respect to what conditions get to be in there. They are required to JUSTIFY their decisions. Lobby group pressure is a major driving force in the American Psychiatric Association's decisions. Homosexuality was removed because of lobby group pressure from gay rights activists. Post Traumatic Stress Disorder was included because of lobby group pressure from war vets. Bentall refers to both of these as a 'triumph of the doctrine of truth by agreement'. The idea is that... Including Post Traumatic Stress Disorder as a disorder in the Diagnostic and Statistical Manual legitimated the suffering of war vets and enabled them to receive treatment (though not under parity, of course!)

When a condition is recognised by being included in the Diagnostic and Statistical Manual it becomes a focus of attention for researchers to study the nature, progression, causes, effective treatments etc. It also becomes a focus of research funds. More research funds are available for people to study DSM recognised conditions (such as PTSD) than non-recognised conditions (e.g., 'sub-threshold bi-polar or premenstrual dysphoric disorder). The more conditions are listed in the DSM the more the prevalence of mental disorder goes up in the population. The American Psychiatric Association needs to be careful... If they start saying that prevalence of mental disorder is 100% or 99% or 85% then that would be too hard to credit. Criteria for diagnostic categories are often tweaked in an attempt to adjust prevalence rates to something more credible (for example the tightening up of the 'dissociative identity disorder' criterion by reinstatement of the amnesia requirements in order to try and curb the 'epidemic' that some people were finding a little hard to credit).

Drug companies are another lobby group pressure on the American Psychiatric Association. That kind of lobby group pressure is beneficial to the American Psychiatric Association, as is the lobby group pressure of war vets etc. The development of (I think it was) xanax as a (relatively) successful treatment for a certain sub-set of people with anxiety led to 'Panic Attacks' being recognised as a particular kind of disorder in the Diagnostic and Statistical Manual. Everybody likes a success story and part of the reason for including this as a seperate condition is that psychiatry now gets to claim this as a success story - here is a condition that we have relatively successful treatment for! See - we are just like medicine!

I forsee that the parity act will result in the health insurance companies becoming a major source of lobby group pressure on the American Psychiatric Association. It will be in the health insurance companies interests to have conditions (especially conditions with expensive treatments) removed from the Diagnostic and Statistical Manual.

Why? Because my guess is that mental health parity will only apply to conditions that appear in the Diagnostic and Statistical Manual. It thus becomes CRUCIAL what conditions are included and what conditions are excluded.

I've heard that there is a lot of talk about removing 'Personality Disorders' from the Diagnostic and Statistical Manual of Mental Disorders? Is this totally unrelated to the parity act? I think not...

The development of 'rapid cycling bi-polar' and 'bi-polar II' are picking up the slack of reluctance to diagnose 'borderline personality disorder'. I'm just saying that I think the parity laws will result in health insurance companies being a major driving force in the revision of subsequent editions of the DSM. It wouldn't surprise me if it ended up being cost effective for insurance companies to employ scientists to test (and attempt to undermine) the efficacy of treatments. Could be an interesting counter-force to the drug company studies and the studies run by psychologists where both seek to establish the efficacy of their treatments...

Psychologists and psychiatrists and drug companies (and the consumers who believe they need them) might well need to pull together!