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

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!

“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.”

I don’t usually promote activities here but now is an exception. Recent posts on the DSM-5 and all that it reveals about the ways our culture relates to human emotionality have drawn new readers (much thanks to everyone who’s reposting!). I’ve been introduced to many others who are writing, blogging, and generally working hard to expand the dialogue and to share “best non-diagnostic practices.”

Which is why I decided to share one of the programs of my Institute—Social Therapy as Clinical Practice. They’re training weekends being held in March, May and November, 2012 in New York City. They’re open to social workers, counselors, psychologists, medical professionals, and educators who favor non-diagnostic, relational approaches to mental health.

Interested?

Social Therapy as Clinical Practice

Social therapy is the group-oriented, development-focused psychotherapy that relates to people of all ages as performers and creators of their lives. Its unique approach to emotionality as social activity places it at the cutting edge of postmodern therapeutic approaches.

Intensive training weekends are an effective way to learn this powerful approach to group therapy. Each four-day training will focus on a specific aspect of social therapeutic method introduced experientially through diverse learning activities: social therapeutic role-plays, observations of therapy groups, reflection sessions with social therapists, group supervisions, and seminars linking theory and practice.

2012 Schedule

Thursday-Sunday, March 8-11

Thursday-Sunday, May 17-20

Thursday-Sunday, November 29-December 2

Fee

$475.00 per training weekend. 20% discount on two or more.

To learn more about social therapy and/or download an application, go to http://www.eastsideinstitute.org/ClinicalTraining.html or contact Christine LaCerva at clacerva@socialtherapygroup.com.

Want to read something first?

Psychological Investigations: A Clinician’s Guide to Social Therapy Edited by Lois Holzman and Rafael Mendez  Psychological Investigations explores the nature of the social therapeutic group process, the social therapeutic relationship, and applications to health care, alternative medicine, education and youth development. The book features over 70 dialogues between Fred Newman, the creator of social therapy, and therapists-in-training, These dialogues, together with introductory overviews by Lois Holzman and Rafael Mendez, are a provocative invitation to both new and seasoned professionals seeking alternative modes of practice and understanding. (Brunner-Routledge, 2003)

Let’s Develop! A Guide to Continuous Personal Growth

by Fred Newman with Phyllis Goldberg

In a culture of “getting,” this is the little book that keeps on giving. The 2010 edition of Fred Newman’s Let’s Develop! has a foreword by Patch Adams (the peripatetic, clowning MD) and new introduction by Lois Holzman. Based on 25 years of clinical practice and his discovery that people can reinitiate development at any stage in life, Newman urges his readers to eschew insights, explanations or getting to the “bottom” of deep-rooted emotional problems and seek their cure in development.

 

 

 

Here’s some other voices speaking about the DSM-5.

First, Dr. Anthony Rao. Tony is a pediatric psychologist, founder of Behavioral Solutions in Lexington MA, and author of The Way of Boys: Promoting the Social and Emotional Development of Young Boys. I met Tony in 2010 when I interviewed him and Christine LaCerva, director of the Social Therapy Group and of clinical training at the East Side Institute, on the topic, “Breakthroughs in Child Psychology” (view on You Tube). Both Tony and Christine work with children diagnosed with ADHD, autism and Asperger’s and, while one practices cognitive behavioral therapy and the other social therapy, we discovered in the interview how much they shared. Tony recently appeared on Boston TV commenting on the DSM-5. Here’s the video clip.

I also heard from Sami Timimi, a Child and Adolescent Psychiatrist and Director of Postgraduate Education in the National Health Service in Lincolnshire, UK. He told me about a campaign he launched a few months ago—“No More Psychiatric Labels.” It’s an interesting read, especially refreshing coming from a psychiatrist. Here’s the concluding paragraph:

By lazily importing the diagnostic model from general medicine we end up miss-selling and under-utilising the unique skills the profession of psychiatry brings to healthcare by the ‘dumbing down’ of what we do into simplistic diagnosis driven protocols that has more to do with successful consumer culture marketing than science. Changing to more evidence compatible paradigms is now long overdue.

I’m glad to be introduced to Dr. Timimi, who has written several books on critical psychiatry that I plan to mull over.

A friend sent me a link to the Association for Women in Psychology information on “Bias in Psychiatric Diagnosis: Concerns about DSM-V” complete with petitions. I plan to read up on this initiative.

Please let me and my readers know of others saying interesting things!

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.

October 3, 2012

Here’s a more graphic rendition of the Performing the World invitation and call for proposals.

October 2, 2011

I’m thrilled to announce the next Performing the World (PTW) conference/festival, “Can Performance Change Save the World?” to take place in New York City October 4-7, 2012. Proposals are due March 1, 2012.

The theme of the last PTW, held in 2010 and attended by over 500 people from dozens of countries, was, “Can Performance Change the World?” The depth of the challenges facing humanity two short years later have led the conveners of Performing the World to recast the question for the 2012 conference as, “Can Performance Save the World?”

Performing the World (PTW) was born in a conversation between East Side Institute co-founder, the late Fred Newman, and me at the end of the summer of 2000. We had already “discovered” performance, and its essential role in human development and learning was key to the therapeutic, educational and community-organizing work of the East Side Institute and its broader community. At the same time, Newman and I were also having conversations with Ken and Mary Gergen, leading social-constructionist psychologists who themselves were turning toward performance, particularly by experimenting with new performatory modes of presenting research and scholarship. During the 1990s at annual meetings of the American Psychological Association, we and the Gergens did some joint performatory symposia and Newman’s original “psychology plays” were performed—all to great enthusiasm. We were encouraged, and wanted to do something bigger and of our own structure.

My international travels had introduced me to many different performatory practices initiated at both the grassroots and from within the universities. I met dozens of people and heard of hundreds more who were using performance to help people and communities grow and create positive social change. We decided to reach out to those doing this work/play—from community organizers to business people, from artists to social workers, from therapists to teachers.

The first Performing the World conference was held in October 2001, just a few weeks after 9/11. Hundreds from all over the world showed up at the beautiful ocean side village of Montauk, 120 miles from New York City, as if this kind of gathering was what they and their communities needed at such a moment.

There have been five PTWs since then. The last two—in 2008 and 2010—were held in New York City, bringing the conference to one of the most vibrant and diverse cultural centers of the world and partnering with the All Stars Project as co-sponsor. PTW has been greatly enriched by having the All Stars’ performing arts and development center on 42 Street near Times Square as the conference’s home base and by the inclusion of hundreds of young people and adults who participate in its programs. Additionally, both the Institute and the All Stars reach out to friends across New York City’s many communities to provide housing for PTW participants and broaden the “performance space.” I am inspired by the growth of the global performance movement and the role that PTW is playing in it, as not only a conference/performance festival but also a unique community event bringing people together to perform a new world.