May 4, 2012
There’s an extensive and excellent discussion of the DSM-5 controversy on Therapy Today.net , an online publication of the British Association for Counselling and Psychotherapy. The article—“Diagnostic Disarray” by Catherine Jackson, Therapy Today’s Deputy Editor, which appeared in April—is unique compared to the dozens of news items, essays and critiques of the DSM-5 and diagnosis appearing this last six months or so, in several ways:
- It’s comprehensive, laying out the politics (discrimination of particular groups and behaviors, the narrowing of mental life to the biological); economics (profits to drug companies, the APA and professionals); science and ethics (lack of evidence for diagnoses, and the limits on what choices we have of how to understand emotional distress and get and give help) of the DSM and its critics
- Jackson includes the opinions of the clients/consumers/patients on what diagnosis means to them
- We get a view from outside the US and how diagnosis looks in the UK and other countries where the DSM is not (yet) required by everyone who does therapy or counseling
- The article hints at the broader than psychiatry-psychology-psychotherapy problem with the diagnostic way of life as an increasingly intrusive and controlling aspect of our overall culture
One person Jackson quotes is Peter Kinderman, Professor of Clinical Psychology at the University of Liverpool and spokesman for the British Psychological Society on the DSM debate. Jackson writes that, according to Kinderman,
DSM-5 is making a bad system worse. ‘It’s trying to pathologise a vast swathe of human nature and social problems as symptoms of mental illness. It makes people look for biomedical solutions to social problems, and it allows people to prescribe medical solutions to social problems. We should be identifying people’s problems, formulating an intelligent hypothesis about why they have them, and then doing something about them. That is different from diagnosis….Where medication is helpful, it should be identified as such. But attaching the label “major depressive disorder” to someone doesn’t tell us if the drug is going to help the person or not, and the vast majority of people with a mental health problem would benefit more from therapy than from drugs. The label carries stigma; it means they haven’t got problems that are part of normal life.’
Another British voice in “Diagnostic Disarray” is Pete Sanders, retired counsellor and trainer, a trustee of Soteria Network and founder of PCCS Books. He told Jackson,
‘There is an ideological battle going on. We are seeing an alarming medicalisation of everyday life. You can’t be sad any more; you have to be depressed. You can’t be shy any more; you have to have social anxiety disorder’.
He also told Jackson that the whole mental health care system has to change. This change, he believes, will inevitably come from the bottom up, and he advises therapists to seek out their nearest mental health user or survivor group – for example, the Hearing Voices Network or Mad Pride – and support them.’
I agree with the bottom up approach, but it should be much more inclusive than Sanders’ vision. Most people who seek psychotherapy or counseling aren’t part of organized mental health user or survivor groups. And it’s my experience as a community organizer that they don’t need to be. But they do need to learn what’s going on here and be given the opportunity to organize with others, including their therapists and counselors, as a force for change.
Please write me if you know of organizing of this sort going on. I’ll be part of one event on June 8 when I join Gil Eyal, Columbia University sociology professor and co-author of The Autism Matrix: The Social Origins of the Autism Epidemic, and Christine LaCerva, director of the Social Therapy Group and the Institute’s director of clinical training, for a public conversation.
Click here to read the complete article, “Diagnostic Disarray.”