Other dissenters were pointing to important cultural biases in DSM—and this concern was becoming increasingly important as DSM was being used increasingly in other countries. It was only later that the fortress walls were breached, and intense controversy occurred inside the mental health community leading to some important changes in DSM. We turn now to these controversies and changes.
Current Challenges in the Use of DSM
By the turn of the 21st Century, strong opposing viewpoints were being articulated regarding both the process and content of DSM. Concerns were expressed from many elements of the mental health community regarding who was sitting at the table when decisions were being made regarding DSM categorizations and descriptions. The psychologists, clinical social workers and other nonmedical members of this community now had some clout and were benefiting from governmental and third party funding: DSM was making a real difference in the financial life and choice of treatment strategies for these professionals and they wanted to be at the table.
There were also major concerns voiced about the content of DSM. While there are many sources of these concerns and many areas in which controversy has arisen, we will focus on just two: (1) homosexuality and gender identity, and (2) post-traumatic stress disorder. We also turn to the challenges posed at the present time by two major sources of societal disruption and potential mental illness: (1) COVID-19 and (2) racism and political polarization.
Sexual Orientation and Gender Identity
The contemporary societies in which most of us live are now experiencing a growing recognition, acceptance, and even open support for those members of society who are homosexual, bisexual or transsexual. The LGBTQ community is alive and well—public recognition is here to stay. There is also recent and growing recognition and acceptance of diffuse gender identity—the desire of some members of our society to break out of traditional gender categorizations and constraints. Gender nonconformity is also alive and well—though perhaps not as widely accepted as diverse sexual orientations. With this shifting societal perspective regarding sexual-orientation and gender identity comes many challenges in all domains of society—including mental health. When it comes to the diagnoses of nontraditional sexual-orientation and diffuse gender identity as mental illnesses, we witness a “perfect storm” in the collision of all the assumptive worlds identified in our previous essays.
