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When does the use of Viagra represent a medical necessity? In psychiatry, faulty criteria camouflage such treatment and allow the issue to be avoided. One cost of this avoidance is that some critics use the expansiveness of the DSM criteria to argue against reimbursement parity for mental-health care. When the issue of parity arises, the first objection sure to be heard is that such parity would break the health-care bank because it would allow every instance of normal unhappiness to qualify for treatment.
Such objections are buttressed by the ridicule frequently heaped on DSM criteria in the popular media. A more honest discussion of normal versus abnormal conditions and their appropriate rights to reimbursement might help to address some of these objections. Family advocacy organizations, such as the National Alliance for the Mentally 111 (NAMI), which became an influential political force during the 1980s, have at the top of their political agenda the achievement of insurance reimbursement parity for mental disorder. Their major argument is that certain mental disorders as currently defined, including depression, are biological disorders, just like physical disorders,and deserve to be treated equally with respect to reimbursement.
Admitting that current DSM criteria fail to distinguish true depressive disorders from normal sadness reactions would certainly muddy this argument, and appears to go against these groups’ agendas. In the long run, however, the case for better treatment might be strengthened if such a distinction was carefully made and the conceptual flaws in current criteria eliminated, so that the criteria did indeed pick out only plausible cases of disorder. The truly disordered would then become the more exclusive focus of treatment and resource allocation.
