The DSM and Gender from a Patient's Perspective

John McManamy Health Guide
  • If only I had advance warning, time to prepare. Instead, here I was, new at the game, seated unexpectedly at a dinner symposium next to Robert Spitzer MD, the man responsible for the modern DSM. (See my three blogs, "DSM: A Common Language for Understanding Mental Illness," and "What to Say to the Man Behind the DSM?".) The people who should have been asking him questions were too busy buttering their bread and figuring out which water glass to reach for. The burden of opening the conversation fell on me, the least knowledgeable person at the table.
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    I introduced myself to Dr. Spitzer as a bipolar patient who was at this particular psychiatric conference as a journalist. As a patient, I had a few thoughts of my own about the DSM, I continued. Would he be interested in hearing them?

    This is like telling Einstein that I had a few thoughts about relativity, but Dr. Spitzer indicated that I proceed.

    I decided to stick to the one aspect of the DSM where my thinking had crystallized. This concerned the issue of gender and depression. Here I was on fairly solid ground, for many experts were pushing for changes to the DSM on this matter. My view, and the view of these experts, is that the DSM symptom list is biased toward picking up depression in women while men suffer in silence. According to conventional wisdom, twice as many women experience depression as men. But a bit of tweaking to that symptom list, I argued, could even out that equation.

    I waited for the go-ahead, then proceeded down the list. Symptom one is “depressed mood most of the day,” and the unfortunate example is “appears tearful.” Men, by contrast, express themselves in other ways or else fail to express themselves at all. Number three concerns weight gain or loss. Think of what women go to the fridge for when feeling low. Now think of what men reach for. Symptom seven is about worthlessness and guilt, but men tend to lash out and blame others. Last but not least is suicidal thinking. Men fall victim more often than women, but women make far more attempts, and so are more likely to come to the attention of the profession and be treated.

    Dr. Spitzer pondered my comments, then, as psychiatrists are wont to do, said nothing. By now, the main course had come out. Any further conversation was light and inconsequential, directed at the others at the table. Soon the first of several speakers started talking. It was time to go to work, to take notes.

    Two hours later, the last of the speakers wrapped up. Question time was just ahead. Most members of the audience use this brief interval to leave, and so it was that Dr. Spitzer got up to make his exit, but not before addressing me.

    “I thought about what you said,” he told me, or words to that effect. And then his verdict: “And I don’t go along with any of it.”

    Then he rose from his chair and was gone.

    Hey, what did I know? He was Robert Spitzer, founder of modern psychiatry. I was just a male bipolar patient who had to deal with depression every day of my life. Like I said, what did I know?
Published On: February 02, 2006