Check out my guest column in Psychology Today’s Rethinking Psychology (Eric Maisel’s column)

“Cosmetic Changes to the DSM-V (Did the DSM-5 Task Force Really Back Down?)”

Recently the DSM-5 Task Force of psychiatrists dropped two diagnoses from its new manual—“attenuated psychosis syndrome” (proposed to identify people at risk of developing psychosis), and “mixed anxiety depressive disorder” (a hybrid of two mood problems). This is welcome news to both mental health professionals and the people who utilize them. (The story was reported widely, including in The New York Times: “Psychiatry Manual Drafters Back Down on Diagnoses” (May 8, 2012).

At the same time, in dropping two diagnoses and “tweaking” some others because of lack of evidence, the DSM-5 Task Force of psychiatrists is perpetuating the belief that they are doing science. READ MORE at Rethinking Psychology

The Institute jumped into the free webinar field at the beginning of this year.

It’s much simpler than I would have thought! We give people access to an audio or video. After listening/viewing, they can join an hour-long live chat, email questions and comments, or do nothing. I’ve led the online chat twice (with other Institute faculty doing the others) and I really enjoy how much we get to know each other through the improvisational conversation we create out of questions and comments.

The May webinar is on social therapy. The material is an audio interview a Brazilian psychologist conducted with me two years ago when I was in Brazil. (It’s in English.) I trace  some of the history of social therapy. I introduce my work as a post-doctoral student in Michael Cole’s laboratory at Rockefeller University in the late 1970s and my meeting Fred Newman and founding the East Side Institute. The interview presents some of the highlights of the next 40 years of engagement and conversations with radical and critical psychologists, social constructionists, humanists, Vygotskians, Marxists, activity theorists, and the narrative therapy movement. People who’ve listened to it really like it! (I’ll be listening to it before the chat!)

If you’re interested, the interview is available at http://eastsideinstitute.org/audio_files/LHolzman%20Ricardo%20Lana.WAV at your convenience.  I’ll be leading the instant chat on Friday, May 18, 12:00 PM EST. Contact Mary Fridley at mfridley@eastsideinstitute.org for webinar registration.

If you can’t make it, you can share questions and comments at webinar@eastsideinstitute.org.

In addition to Catherine Jackson’s thoughtful and comprehensive overview of the issues involved in the DSM-5 controversy I wrote about  yesterday, there’s some other worthy reading. That’s partly due to the American Psychiatric Association (APA) holding its annual meeting this weekend in Philadelphia. Last week the APA posted the latest draft of the proposed changes to the manual on its website and it will be a major agenda item among this 10,000 member organization.

Whatever happens inside the convention halls, what goes on outside is equally newsworthy. Demonstrations planned by Occupy the APA are bringing medical and social work professionals together with concerned citizens, psychiatric patients and consumers to peacefully protest the many troubling aspects of DSM-5.

Some articles to check out:

How do controversial revisions in psychiatry’s guidebook make you feel? by Stacey Burling in the Philadelphia Inquirer 

This Weekend, Philadelphians can say “Screw You” to Normal by Liz Spikol in the Philadelphia Magazine blog

Protestors, Rejecting Mental Illness Labels, Vow to “Occupy” the American Psychiatric Association Convention is a press release  from MindFreedom International (MFI), an independent voice of survivors of psychiatric human rights. 

An article in the Minnesota Post entitled Last Chance to comment on psychiatry’s controversial diagnostic “bible” by Susan Perry speaks to a number of the controversies of DSM-5 including adding bereavement to the definition of depression.

On a hopeful note, Maia Szalavitz writes for Time.com that the public debate and petition signing is not falling on totally deaf ears:  DSM-5 Debate: Committee Backs Off Some Changes, Re-Opens Comments. 

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.”

Right after being at TEDMED I flew to Vancouver, British Columbia for the annual meeting of the American Educational Research Association (AERA). There are 25,000 members! And about half that number actually come to the five-day meeting. These are the folks who teach education courses at colleges and universities and train new educational researchers, their graduate students, directors and program people at research and evaluation organizations, deans and administrators and advocates. So many educated people!

I’m a long-time AERA member, I present something each year, and I just finished my tenure as chair of one of its many (SIGs) Special Interest Groups—Cultural-Historical Research. For three years I’ve been leading the effort to bring play and its importance to the learning process to AERA. This is no small task, as play is nowhere to be found in this organization. A look through the 300+ entries in the annual meeting program index comes up empty for play, performance and creativity (and overflowing with assessment, evaluation, curriculum studies, special education, and school reform). And a few years ago, a petition to form a Play SIG was denied by the association.

Be that as it may, my SIG—Cultural-Historical Research—is one of the very few that annually sponsors sessions on play and/or performance. And this year, we had a great one! For our meeting/social hour, we featured a brief talk by Graduate Student Award winner Tony Perone,  and a panel organized by Carrie Lobman featuring play researchers/advocates Joan Almon (Alliance for Childhood), Mike Askew (Monash University), Andrew Burton (Street Spirits Theatre Company),  Artin Göncü (University of Illinois-Chicago), and Jaime Martinez (NY Institute of Technology). They involved the audience in some simple play activities and each speaker was as passionate, compelling and playful as any TEDMED speaker I heard earlier that week. The crowd was small and it’s my hope that the new SIG officers will continue to reach out and build the play movement within AERA.

I also attended a session in which part of the discussion was how it was hard to be a Vygottskian educator in the US and countries that are following the US model (which, one speaker, called “a road to hell”). As it often does among researchers, the conversation among speakers and the audience turned to talk of teachers, including their “resistance.”  My experience in these kinds of discussions is that they go nowhere fast. So, when called on I said I was speaking as a community organizer. I told them that one of my missions has been to make Vygotsky a household word by speaking with kids, parents— everyone—about learning and developing. Parents and students need to be let in on the way learning is understood, how they are being taught, and hear of other approaches including Vygotsky’s. I asked them why they were only speaking of and to teachers and urged them to open up the conversation about a Vygotskian understanding of the learning-developing process. I got some applause and sat down.

While its politics aren’t particularly conservative, AERA is very conservatively organized and structured and, as such, it contributes to its members remaining conservative—comfortable with what and who they already know and do, even if the impact on the everyday lives of children and educators is minimal. I’ll keep organizing!

I survived— and thrived at—TEDMED at the beautiful Kennedy Center in Washington, DC two weeks ago.  Survived being with 1500 people I didn’t know and who didn’t come with an interest in mental health, diagnosis or the politics of psychology and psychiatry. Thrived on hearing 70 or more passionate and smart people speak  of their (mostly amazing) work in medical and pubic health research. Right now the bios of the speakers are available and I’ve heard the talks will soon be there too. Some of them were spectacular and all of them had something worthwhile, so look for them.

I and 50 others were guests at the conference, invited to participate as audience and to advocate during the breaks for Great Challenge topics that they came up with and assigned us. Mine was “Deciding What’s Normal.” Others ranged from “Inventing Wellness Programs” (the top vote getter), “The Caregiver Crisis” (came in second), “Choosing Better Foods,” “Preparing for Dementia,” and “Eliminating Medical Errors.” We weren’t set up particularly well, given that the main activity was listening to the speakers (and we weren’t among them). Our Challenges were printed online and an hour over the three days was set aside to meet us.

You won’t be surprised that my great challenge was to interest people in an abstract, essentially philosophical, topic amidst clear and concrete competition. I played around with how to do this, trying a variety of opening lines. When people asked me, “What’s #44?” (that’s all it said on my badge), I told them and then asked them a few questions from a survey I prepared to introduce the DSM-5 topic:

If you’re mourning the loss of a loved one three months after he or she passed away, are you normal?

Not according to the newly revised DSM-5. You have Major Depression Disorder.

If you’re having “senior moments” or occasional forgetfulness, are you normal?

Not according to the newly revised DSM-5. You have Minor Neurocognitive Disorder.

If you’ve stopped drinking coffee and have a headache the next day, are you normal?

Not according to the newly revised DSM-%. You have Caffeine Withdrawal Syndrome.

If you’re a member of the DSM-5 Task Force and have financial ties to the pharmaceutical industry, are you normal?

Yes! 70% of the Task Force are psychiatrists who get money from pharmaceutical companies.

Nearly everyone I spoke to was disturbed by this, most thoughtfully so but some in the “ho hum, so what” way people can be when they decide not to engage in thinking or talking about something that seems too big to tackle. When we got into conversation people invariably told me of their experience (mostly bad) with therapeutic diagnosis. I also played with not being normal and praising them for not being normal either (getting smiles) and giving out a passage from a speech by Dr. Martin Luther King, Jr. on being proud to be maladjusted. I met some interesting and interested people and made a baby step toward getting the TEDMED community to pay attention to mental health.

Deciding What’s Normal. What a great topic for me to lobby folks around at the TEDMED conference this coming week in Washington, D.C. The topic and I are 1 of 50 “Great Challenges” in health and medicine that will be represented at the conference, along with the usual program of speakers and dinners and networking. I’m thrilled I was chosen as a Great Challenge Advocate, and look forward to discovering and creating what that means! Of course, I’ll be talking about the DSM-5 controversy.

I’m also excited to attend the whole conference. I love TED Talks. I tell people where ever I go to watch one every day—for their health. A few weeks ago I gave a TED Talks “course” at the All Stars Project’s free university-style development center for people of all ages, showing one talk each week, followed by discussion and some performance exercises. It’s very gratifying to see people create conversation and joy in how they’re learning and growing together!

Here’s the description of my Great Challenge:

Deciding What’s Normal
The Diagnostic and Statistical Manual (DSM) is about to be revised for the fifth time, redefining what counts as mental pathology and what doesn’t.

There’s already controversy about making it harder to diagnose Asperger’s syndrome, and making it easier to count grief as a treatable “condition.” But it’s not only psychiatry where the boundaries of normal will shift. They also shift with blood pressure levels and cholesterol levels, to name several major parameters. (The metrics themselves don’t change — just the ranges that are considered “normal” readings.)

These definitions have huge implications in terms of insurance coverage and reimbursement, pharmaceutical development, and our very sense of ourselves. Who should decide what’s “normal” — and how?

Today I read Joanne Cacciatore’s blog. She’s the founder of the MISS Foundation, an international nonprofit organization with 75 chapters around the world aiding parents whose children have died or are dying at any age and from any cause. (She’s also a professor and researcher at Arizona State University and a psychotherapist.)

A few weeks ago Dr. Cacciatore wrote an entry, “DSM5 and Ethical Relativism,” opposing the proposed change in the DSM’s “bereavement exclusion,” which has to do with how much time you can grieve the death of a loved one before you’re deemed pathological (specifically, having a Depressive Disorder). It turns out that in the DSM-III, in use from 1980-1994, the bereavement exclusion was two years. Then its replacement, the DSM-IV, reduced it to two months. And the new DSM-5 wants to reduce it again, this time to 2 weeks! Talk about crazy!

Dr. Cacciatore’s blog went viral and within two weeks had 100,000 readers. She was prompted by this response and the outpouring of comments to write an Open Letter to the Board of Trustees of the American Psychiatric Association and to the DSM 5 Task Force (dated March 21, 2012) on behalf of these many thousands of people. She notes in her letter that “there is no empirical standing for the arbitrary two-week time frame, and thus this proposal not only contradicts good common sense but also rests on weak scientific evidence” and that the proposed revision “challenges what it means to be human and for some may be dangerous.”

It’s a strong letter. Spread the word!

A big thank you to Dr. Eric Maisel for having me as a guest blogger at his Rethinking Psychology column at Psychology Today. Check out the 3/16/12 post, asking “What if client and mental health provider co-created a diagnosis?”And become a regular reader of Rethinking Psychology.

“After the 1994 release of DSM-4, the APA instituted a policy requiring expert advisors to disclose drug industry ties. But the move toward transparency did little to cut down on conflicts, with nearly 70 percent of DSM-5 task force members reporting financial relationships with pharmaceutical companies—up from 57 percent for DSM-4.”

This was disclosed on ABC World News tonight (3/13/12) during the segment: “DSM-5 Criticized for Financial Conflict of Interest.” Surprised?

I’m not. As pharmaceuticals go, so goes psychiatry. (And as psychiatry goes, so does clinical psychology, mental health counseling and social work, which means millions of ordinary people are affected.)

Why would it cause problems for a DSM-5 Task Force member to disclose that he or she conducts research funded by the drug industry, or is a spokesperson for a specific drug or a paid advisor for a particular company? After all, they’re the experts! Who made them so? The APA and the pharmaceuticals, of course. It’s a self-legitimizing, self-congratulatory, pseudoscientific  closed circle.

If you think this is a bit (or a lot) hyperbolic, the APA medical director and CEO James Scully said pretty much the same thing, no doubt without a trace of irony:

“We wanted to include a wide variety of scientists and researchers with a range of expertise and viewpoints in the DSM-5 process. Excluding everyone with direct or indirect funding from the industry would unreasonably limit the participation of leading mental health experts in the DSM-5 development process.”