The Real Problem with the DSM-5

04 Jan The Real Problem with the DSM-5

January 4, 2012

I’ve been following the controversy over the latest revision of the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM-5. Compiled and published by the American Psychiatric Association, the DSM is the diagnostic bible for mental health professionals the world over—and a cash cow for the Association (which, by some accounts, earns $5 million each year from sales of the book), the pharmaceutical multinationals and health insurance companies. The DSM has undergone five revisions since it first appeared in 1952 and while each has had its share of critics, the proposed DSM-5 is getting serious pushback, complete with a petition and grassroots campaign among psychiatrists, psychologists and other mental health providers.

Here’s a summary statement of what’s viewed as problematic from An Open Letter to the DSM-5 Task Force circulated by the Society for Humanistic Psychology Division of the American Psychological Association:

Though we admire various efforts of the DSM-5 Task Force, especially efforts to update the manual according to new empirical research, we have substantial reservations about a number of the proposed changes that are presented on www.dsm5.org.  As we will detail below, we are concerned about the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory. In light of the growing empirical evidence that neurobiology does not fully account for the emergence of mental distress, as well as new longitudinal studies revealing long-term hazards of standard neurobiological (psychotropic) treatment, we believe that these changes pose substantial risks to patients/clients, practitioners, and the mental health professions in general.

By mid-December, nearly 10,000 had signed the petition, prompting its initiator David Elkins (professor emeritus at Pepperdine University and president of the Division) to comment, “This has become a grassroots movement among mental health professionals, who are saying we already have a national problem with overmedication of children and the elderly, and we don’t want to exacerbate that” (quoted in Salon).

I signed the petition. I spread the word and urge others to sign. I’m encouraged by the support the petition is getting, for it’s giving mental health professionals a way to voice their dissatisfaction with the institutionalized constraints of their work (which include the hard fact that if they didn’t use the DSM they’d be out of a job).

And yet… As supportive of this reform effort as I am, I’m not a reformer. Of course we shouldn’t OVERdiagnosis. Critiquing the DSM-5 because it “goes overboard” is one thing. Critiquing the diagnostic paradigm and the entirety of the medical model approach to human emotionality is another. Thousands of people have been helped with their “mental illness” through social therapy and others approaches that relate to human beings with integrity, that is, as human beings and not as brains, minds, bodies and/or behaviors. That relate to mental health/illness as an issue of emotional and relational growth. That don’t depend on a so-called objective assessment of a person’s “illness” by an “expert” who consults a manual that was made up by other “experts.”  And I do mean made up. The DSM is authoritarian through and through—and as far from authoritative as can be.

Fred Newman, my mentor and colleague, was a big critic of the mainstream, and he created the social therapy alternative. He got a lot of flak for it from the protectors of the status quo. Not because he objected to its “excesses,” but because he objected to its misguided and destructive “essence.”  For one of our books, Unscientific Psychology: A Cultural-Performatory Approach to Understanding Human Life, I did a lot of research on the history of how psychology created itself. For the chapter, “Psychology’s Best-Seller: Mental Illness and Mental Health,” I drew upon some excellent critiques and exposés of the medical model, pseudoscientific approach to mental health, and the chapter presents the political, economic and cultural foundations and impacts of psychology’s understanding of mental illness, and the blatant opportunism of various players who created the industry. I wish some of this back-story was part of the current campaign against the DSM-5.

I end this rather long post with something Newman and I wrote in Unscientific Psychology. With the DSM-5 revision process and grassroots movement against it going on, it’s as good a time as any to give the book a read.

Psychology has no subject matter; not in the sense that there is no such thing as human subjective (conscious) relational experience or uniquely human interaction, but in the sense that such activity, such life, is essentially inseparable from its study by those (human beings) who participate in it. A star is, presumably, “starring” whether it is seen or not. But a human seer (a perceiver) cannot be consciously seeing unless one is seen—if only by “oneself.” The study of subjectivity cannot possibly achieve the distance required to be a science. Therefore, psychology, in its vulgar commitment to its own existence and cash value, creates that distance. But in doing so it “loses” its subject matter! Scientific psychology is, in our story, an ancient religion in modern (scientific) dress.