I recently wrote a post called DSM-5: Another Step in the Wrong Direction. In that article I argued that DSM-5 was simply another step in the APA’s ongoing agenda to medicalize all human problems and to legitimize the administration of drugs as the front line “solution” to these problems.
I also expressed concern that the widely publicized movement to develop an alternative diagnostic system might not look all that different from what we have today.
Dr. Brent Robbins, PhD, co-chair of the International DSM-5 Response Committee, commented on the article, and you can see his comment here. Dr. Robbins points out that the committee intends to highlight major weaknesses of the DSM-5, with particular reference to its lack of scientific reliability and validity.
He also mentioned the Diagnostic Summit Committee, whose purpose is to “open up an international conversation about alternatives to DSM-5.”
Dr. Robbins also draws attention to the committee’s petition. This is a seven-page document, with a further two page membership list and two pages of references. The petition identifies various problems with DSM-5, and discusses some of the history and implications of these problems. In my view, all the criticisms of DSM-5 listed in the petition are valid. DSM-5 definitely represents a step in the wrong direction.
IT’S NOT DSM-5, IT’S DSM
However – even if DSM-5 were to be scrapped in its entirety – we would still be in dire straits, because the problem is not DSM-5; the problem is DSM. My position is that there are no mental illnesses; that the concept of mental illness is archaic, pre-scientific nonsense, exactly on a par with the notion of witchcraft. Arguing against DSM-5 without also challenging the concept of mental illness is analogous to saying that too many women are being persecuted for witchcraft, and that we need to concentrate instead on the ones who really are witches and who can be identified by the following signs: moles on the nose; odor of cabbage, etc., etc…
The gist of the petition can be found on page 6:
4. “Clients and the general public are negatively affected by the continued and continuous medicalization of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences that demand helping responses, but which do not reflect illnesses so much as normal individual variation. The mental health professions are uniquely suited for helping to create a better global society. But the application of inappropriate psychiatric labels is not a solution.”
I’m not sure how qualified we are to create a better global society, but otherwise I could endorse this statement without reservation. Indeed it is almost a synopsis of what this website stands for.
But there are a few other places in the document where the authors seem to be accepting the ontological validity of “mental illnesses” generally, but are simply concerned about the extensions of this concept that are contained in DSM-5.
This may simply be careless drafting, or perhaps overly picky reading on my part, but I think these issues should be clarified.
Entering into a debate with the APA over what is and what isn’t a mental illness is a fundamentally flawed strategy for two reasons. Firstly, because the concept of mental illness is nonsense; it’s a bit like discussing latitude and longitude with flat-earthers. Secondly, because the only definition of a mental illness is the one provided by the APA – so if they say something is a mental illness, then it is; otherwise it is not. It’s a decision, not a discovery. There is no objective reality against which to judge the matter. By contrast, the statement, for instance, that all magnets are made from iron can be readily refuted by the production of magnets made from other substances. The problem is compounded by the fact that the APA’s definition of a mental disorder is essentially: any human activity that entails significant problems. So they can include anything they want, provided they can sell it to the public.
By the way, despite my concerns, I have decided to sign the petition, and I encourage readers to do the same. Click here.
ALTERNATIVE TO DSM
The petition makes no mention of developing an alternative to DSM, but the Diagnostic Summit Committee, which Dr. Robbins mentions in his comment, is apparently planning to work in that area.
At one time, in my earlier days, I would have endorsed this kind of endeavor. But now, of course, I’m older, and I wonder if we really need any system for categorizing clients’ problems. Why not simply write down the presenting problem in the client’s own words and use this statement, and any subsequent revisions, as the basis for whatever help is provided?
The medical model isn’t just about drugs. It’s also a mindset. It goes something like this: the patient is sick; my job is to identify the sickness and then heal; the only input I need from the patient is surrender and compliance. Getting away from the medical model, which incidentally most real doctors have already abandoned, involves a very radical shift of ideas, many of which are unspoken. For me, the fundamental concept is that the client is in charge. The client defines the presenting problem. If I re-word this problem in terms of a categorization system, am I not effectively saying: “you call your problem X, but I prefer to call it Y.” Have we gotten off on the wrong foot? And isn’t there even the danger that I may lose sight of who’s supposed to be driving?
The point I’m making is that if we feel a need to develop an alternative way of categorizing clients’ problems, then OK, let’s do this. But let’s make sure that in our pursuit of non-medical diagnoses, we don’t lose sight of the client’s individuality and uniqueness, and his fundamental right to define himself and to steer his own ship. This is particularly important in that many American psychologists are as steeped in the medical model as the psychiatrists. They have won prescribing rights in two states, and are vigorously lobbying to extend these rights nationwide.
Finally, I believe it would be a mistake to involve American psychiatry in these discussions. Psychiatry in this country is a self-serving, destructive enterprise based on pseudo-science. It has prostituted itself shamelessly to the pharmaceutical industry, and it has left a trail of personal and societal destruction in its wake for the past 50-60 years. In its upcoming DSM-5, it has demonstrated clearly that it has no interest in collaborative dialogue with the other professions, and that its only interests are further turf expansion and the administration of drugs to an ever-increasing segment of the population. If the past six decades have taught us anything, it is that genuine mutually respectful collaboration with psychiatry is not possible. The only question that the other professions should be asking is: why in the world would we want to have anything to do with these people? It’s time for a divorce!