Behaviorism and Mental Health

Alternative perspective on psychiatry's so-called mental disorders | PHILIP HICKEY, PH.D.

  • Home
  • About
  • Contact
  • Tell Your Story
  • Submit Your Story
  • Moderation Policy

An Alternative to DSM

June 13, 2013 By Phil Hickey | 3 Comments

fb-share-icon
Visit Us
Follow Me
Tweet

Last month (May 31), National Public Radio (NPR) ran an interview on Science Friday with Thomas Insel, MD, Director of NIMH, Jeffrey Lieberman, MD, President of the APA, and Gary Greenberg, PhD, practicing psychotherapist.

I didn’t hear the interview, but I have read the transcript.  Doctors Insel and Lieberman were spinning the barrage of criticism directed at psychiatry in recent months, while at the same time clinging desperately to the notion that the problems that psychiatrists “treat” are real illnesses.  It’s become a familiar theme, and there was nothing new.

What interested me, however, was a remark by Dr. Greenberg.  Here’s the quote:

“I think, you know, one of the things to consider here is we’re dealing with the clinical reality of a need to be able to understand what people bring to us and to make clinical decisions. Some of us are old enough to remember what psychiatry was like or what clinical care was like for mental illness before we had a DSM-III, before there was a dictionary, and it was chaos. And I don’t think anybody wants to go back to that. I don’t think anybody right now has an alternative for clinical use…”

I was surprised to read these words, because I had always had the impression that Dr. Greenberg was opposed to the widespread spurious medicalization of human problems.

Let’s take a closer look at what he said.

“…the clinical reality of a need to be able to understand what people bring to us and to make clinical decisions.”

As an example here, let’s consider the case of a young man who goes to a therapist and says: “I worry a lot about germs, and I wash my hands about 100 times a day.”

To my way of thinking, this is perfectly clear and perfectly understandable.  Gary seems to be suggesting that assigning this man a “diagnosis” of obsessive compulsive disorder somehow enables the therapist to understand the presenting problem.  In other words, the preoccupation with germs and the frequent hand-washing are explained by the “diagnosis” of obsessive compulsive disorder.  The reality, however, is that the “diagnosis” (unlike real medical diagnoses) has no explanatory content.

Let’s apply the acid test:

Client: Why do I worry about germs and wash my hands so much?
Therapist:  Because you have a mental illness called obsessive compulsive disorder.
Client:  How do you know I have obsessive compulsive disorder?
Therapist:  Because you worry about germs and wash your hands so much.

The “diagnosis” explains nothing.

Back to Dr. Greenberg:

“…And to make clinical decisions.”

I can’t even imagine how replacing the client’s very clear, very specific problem statement with a more general statement, which has no explanatory value, can help in making clinical decisions.

Dr. Greenberg continues:

“Some of us are old enough to remember what psychiatry was like or what clinical care was like for mental illness before we had a DSM-III, before there was a dictionary, and it was chaos.”

Well I can remember back then, and it didn’t seem like chaos to me.  We asked the client what was troubling him or her; sought clarification and details as necessary; listened as carefully as we could for nuances; and worked collaboratively with the client towards solutions.  In the hypothetical case mentioned above, the help provided would be along the general lines of stimuli identification, and graduated exposure adapted creatively to the individual needs and concerns of the client.

Also, we didn’t call these kinds of problems mental illnesses.

“I don’t think anybody right now has an alternative for clinical use beyond what the DSM is providing.”

Behavior therapy since at least the 60’s has used the client’s own statement as the treatment “target,” not as a result of any great insight or study, but simply because it made sense.

In addition, Peter Kinderman, PhD, on May 15 posted So…What happens next? on DxSummit.org.  In this article he proposes the use of a client problem list and psychosocial formulations as a rational substitute for a DSM “diagnosis.”

Psychiatric “diagnoses” were invented by psychiatrists to promote the pretense that they are real doctors, and to legitimize the prescribing of mood and behavior altering drugs.  These “diagnoses” not only don’t help, they are a hindrance.  They have no advantage over the client’s own statement.

I know the advantage to psychiatrists:  without a “diagnosis” they can’t prescribe their drugs.  But why would a therapist find these spurious “diagnoses” useful?

Dr. Greenberg continues:

“So it’s easy to criticize this and to say it’s not a perfect document.”

We have been hearing this a lot from psychiatrists lately.  They say, in effect:  we know the DSM isn’t perfect, but it’s the best we’ve got and we’re working hard to improve it.  This whole line of reasoning misses the point of what the anti-DSM contingent is saying.  We’re not saying that the DSM is an imperfect document in need of tweaking.  We’re saying that it’s rubbish!  It has no validity and serves no useful purpose.  And, in that it legitimizes the pushing of dangerous pharmaceutical products for an increasingly wide range of human problems, it is very destructive rubbish.

The purpose of this post is not to attack Gary Greenberg.  But I have commented favorably on Gary’s writing in the past, and I didn’t want there to be any perception that I was in harmony with some of the positions he took on the NPR interview.

 

 

fb-share-icon
Visit Us
Follow Me
Tweet

Filed Under: A Behavioral Approach to Mental Disorders Tagged With: alternative to DSM, dealing with problems of daily living, DSM

About Phil Hickey

I am a licensed psychologist, presently retired. I have worked in clinical and managerial positions in the mental health, corrections, and addictions fields in the United States and England. My wife Nancy and I have been married since 1970 and have four grown children.

 

fb-share-icon
Visit Us
Follow Me
Tweet

Recent Articles

  • Celebrating the Anti-Psychiatry Movement
  • Dr. Pies:  Still Going Wrong
  • A Psychiatrist Critiques Psychiatry, And Does A Great Job!
  • Dr. Aftab Interviews Dr. Pies
  • Is Psychiatry Dangerous?
  • Deep Sleep “Therapy” in Australia in the 1960’s and 70’s. Could Something Like This Happen Today?
  • Drs. Pies and Ruffalo Still Rattling Their Wooden Swords
  • Allen Frances: Still Spinning the Story
  • The Chemical Imbalance Theory of Depression: Where Is It Going?
  • Dr. Huda Has Written His Book

The phrase "mental health" as used in the name of this website is simply a term of convenience. It specifically does not imply that the human problems embraced by this term are illnesses, or that their absence constitutes health. Indeed, the fundamental tenet of this site is that there are no mental illnesses, and that conceptualizing human problems in this way is spurious, destructive, disempowering, and stigmatizing.

Disclaimer

The purpose of this website is to provide a forum where current practices and ideas in the mental health field can be critically examined and discussed. It is not possible in this kind of context to provide psychological help or advice to individuals who may read this site, and nothing written here should be construed in this manner. Readers seeking psychological help should consult a qualified practitioner in their own local area. They should explain their concerns to this person and develop a trusting working relationship. It is only in a one-to-one relationship of this kind that specific advice should be given or taken.

Privacy Policy

Recent Comments

Popular Topics…

abuse ADHD akathisia alcohol alcohol/drugs antidepressants antipsychotics anxiety benzodiazepines bipolar books worth reading case study chemical imbalance theory conflict of interest dealing with problems of daily living dependence depression drug DSM DSM-5 ECT expansion of psychiatric turf IF THEY'RE NOT ILLNESSES WHAT ARE THEY? involuntary commitment Mad in America major tranquilizers myth of chemical imbalance myth of mental illness neuroleptics over-medicalization of everyday life parenting pharmaceutical industry placebo posttraumatic stress disorder Psychiatric "spin" research corruption schizophrenia shock "treatment" side effects somatic symptom disorder SSRI's suicide survivors of psychiatry violence war on drugs

© 2009–2021