Psychiatrists Argue Over What's Normal for New Diagnostic Book

Is compulsive shopping a mental problem? Do children who continually recoil from sights and sounds suffer from sensory problems – or just need extra attention? Should fetishes really be considered mental disorders, as many are now?

Panels of psychiatrists are hashing out just such questions, and their answers – to be published in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders – will have consequences for insurance reimbursement, research and individuals' psychological identity for years to come.

“This is not cardiology or nephrology, where the basic diseases are well known,” said Edward Shorter, a leading historian of psychiatry whose latest book, “Before Prozac,” is critical of the manual. “In psychiatry, no one knows the causes of anything, so classification can be driven by all sorts of factors” – political, social and financial.

“What you have in the end,” Shorter said, “is this process of sorting the deck of symptoms into syndromes, and the outcome all depends on how the cards fall.”