It’s widely known that the initial drafts of DSM-5 received a great deal of negative comment. It’s also known that some of the more controversial proposals have been scrapped, but that others have been retained and sent for printing.
All of this was fairly predictable. The APA’s agenda is to widen the “diagnostic” net to include as many people as possible. But they’re not complete fools. They know that there’s a good deal of anti-psychiatry feeling out there, so in my view, they floated some very contentious proposals, fully accepting that these would be withdrawn under pressure, thereby creating the perception that they are reasonable folk just trying to do what’s right. Meanwhile, other proposals go under the wire unscathed, and the “diagnostic” net is widened. Mission accomplished.
It has backfired somewhat, however, in that the sheer outrageousness of some of the original proposals has raised serious questions about the validity and destructiveness of the DSM system generally, and these criticisms aren’t going away. As I’ve said many times: the problem is not DSM-5; the problem is DSM (i.e. the spurious and destructive medicalization of ordinary human problems).
I’ve recently come across a paper published by the Society for Humanistic Psychology (SHP: a Division of the American Psychological Association). It’s written by David Elkins, dated October 2012. It’s called: “A brief overview of the DSM-5 reform effort.”
The article recounts in considerable detail the efforts made by the SHP and its parent group the American Psychological Association to have the more controversial DSM-5 proposals scrubbed or modified. The responses of the American Psychiatric Association are also noted.
The report is well worth reading. There was one sentence in particular that caught my eye. The American Psychological Association had requested the American Psychiatric Association to submit the proposed changes for “an outside, independent review by scientists and scholars who had no associations with the DSM-5 Task Force or the American Psychiatric Association.” In their response, the Task Force and the American Psychiatric Association refused the request, stating that “there was no outside group of scholars and scientists that was qualified to evaluate the DSM-5 proposals.”
Whatever else you might say about psychiatrists, they are not bashful or self-effacing.
Anyway, that’s all by way of background. What I really found interesting in the paper was the following:
“In regard to the future, Jonathan Raskin and Frank Farley, members of the Division 32 Open Letter Committee of SHP will chair an international summit in 2013 of representatives from major mental health associations to explore the feasibility of developing an alternative and perhaps parallel diagnostic system that would give appropriate emphasis to psychosocial factors in the causation of psychological difficulties and provide an empirically based foundation for psychotherapeutic interventions that, while recognizing the importance of biological models and treatments, would give much-needed attention to psychosocial and psychotherapeutic approaches.
Now on the face of it, this looks pretty good. But as always, the devil is in the details. Note the word “diagnostic” in the middle of the quotation. This in my view has clear medical connotations. Also of concern is the recognition of “the importance of biological models and treatments.” This seems vague. If a person is having a problem that is rooted in biology and can be treated biologically, isn’t this an illness? I mean a real illness, like diabetes, pneumonia, etc… Couldn’t it almost be considered a definition of an illness?
My concern is that the proposed alternative diagnostic system might not look all that different from DSM. This is a very real concern, because there is an almost identical phrase in DSM-IV-TR. After the definition of a mental disorder on page xxxi, you will find this little gem:
“Whatever its original cause, it must currently be considered a manifestation of a behavioral, psychological, or biological dysfunction in the individual.”
A similar phrase occurs in DSM-III-R, p. xxii.
And we all know where that went – behavioral and psychological factors were routinely ignored and clients were told that their problems were biological illnesses “just like diabetes” and that the only treatment was drugs.
Have we any reason to imagine that psychologists, many of whom are pursuing prescribing rights, will be any less susceptible to the corrupting influence of pharmaceutical dollars than psychiatrists? As a psychologist myself, of course, I would like to be able to say “yes, certainly,” but … who knows? Money tempts. If you let the bio-psychiatrists in, then they will bring in the Big Pharma dollars, and pretty soon we’ll be back where we are today – regardless of what system is used to classify clients’ problems. What’s needed is divorce! Let the psychiatrists continue to sell pills (which is about all they want to do anyway), and let other disciplines develop their own framework for helping clients with problems of living. The link between the two systems should be no more intimate than exists between mental health and general medicine today. Meanwhile, a primary activity among researchers would be to critically scrutinize psychiatry’s routine medicalization of virtually all human problems.
A divorce along these lines has two advantages. Firstly, it allows the non-medical practitioners (psychologists, social workers, counselors, job coaches, case managers, etc.) an opportunity to develop their own conceptual frameworks and programs, free from the constraining tyranny of medicalization. Secondly, it would insulate the other practitioners from fallout as the shortcomings and destructiveness of the psychiatric profession are increasingly recognized and publicized.
For the past 60 years, psychiatry has routinely ignored the concepts and practices of the other disciplines, and has pursued its destructive and self-serving agenda with a callous disregard for the real welfare of clients. DSM-5 makes it clear – if there was any doubt – that nothing has changed.
But the world of communications has changed. We have social media; we have King Google. It’s no longer easy for the APA to marginalize critical voices. A few years ago Robert Whitaker was a relatively unknown journalist with the Boston Globe. Then he wrote a book – Mad in America. Have you seen his website lately? The criticisms are not going away. Psychiatry is taking punches, and if the other disciplines don’t start distancing themselves, they will be tarred with the same brush. Your mother was right: if you hang around with the bad boys, you’ll be seen as a bad boy also.
By the Way
Another gem from Dennis Dodson at National Mental Health Association: “Spring is in the air.” Click here.