The DSM-5 controversy continues, as more professionals and parents share their experiences and opinions regarding specific diagnostic changes and their impact on people’s lives. This is happening on the blogospere and in major media like The New York Times, which in the last ten days has had front page articles, op eds and letters on depression and ADHD and autism. 

The debate goes something like this: Fewer kids will get services if …; Medication is fine, but it’s not everything; But medication was a lifesaver for my kid; Is grieving a sign of depression? Always? If the criteria around grieving changes more people will be diagnosed with depression…and so on.

Lives are at stake, Long-term, no one knows the effects of the drugs that almost inevitably follow a diagnosis of, say, ADHD in a child. Short-term, parents and teachers want something to minimize the chaos they experience, whether that be a drug or special services their children become eligible for with a diagnosis. These are critically important practical policy issues.

But none of this has anything to do with science. The DSM-5 is not a scientific document. To portray it as one is a gigantic hoax. The debate that psychiatrists are having about this and that category of mental disorder is as scientific as a debate about how to classify the different languages spoken by aliens from space. They’re arguing about the very things they themselves made up! They’re debating the virtues of their map but they’re telling us they’re talking about our territory. Have they forgotten that what makes a map a map is the gap between it and the territory? Or are they deliberately disseminating misinformation to the public? Either way, it’s unethical (and takes a lot of chutzpah!).

Some of the experts now speaking say that the science has to get better, that we don’t yet know enough about the brain and biology. They’re just perpetuating the hoax. I’m all for discovering as much as we can about the brain. The men and women working in neuroscience are probably really good scientists—because their research doesn’t violate the brain. The brain is an organ and, from what I’ve read, it’s being studied in ways consistent with what an organ is.

But a person who doesn’t get out of bed? A 6 year-old boy who doesn’t sit still 6 hours a day? A 14 year-old girl who pulls her hair out? Each one of them has a brain, but they are not their brain. Their behavior, their emotional and relational lives, and their pain and distress are social, cultural activities that exist in the world. Relating to them as anything other than this is unscientific.

The notion of science I’m invoking is that it’s an exploratory enterprise that doesn’t violate the integrity of the thing being explored. Diagnosing “mental disorders” in human beings is both a scientific and a moral violation.

So let’s have some honesty in the DSM-5 debate. When it comes to emotional pain, science-talk doesn’t cure. But it does procure.

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!

To go a bit deeper into the underlying problems with the theory and practice of psychology that the controversy over the DSM-5 exposes, I invite you to do some philosophizing.

What assumptions must people be making— about persons; therapy, the therapeutic relationship and therapeutic discourse; illness, cure and treatment; emotions and cognition; and mind, body and brain— in order to have their relationships mediated by a manual? For decades, critical psychologists, postmodern psychologists and philosophers have been exploring this big question. Fred Newman and I included. Here’s some philosophical food for thought from two philosophers who’ve helped us develop our own non-medical model approach—social therapy—and to appreciate discursive, collaborative and social constructionist approaches that reject (to varying degrees) the authority of so-called objectivity when it comes to human life as lived.

First, from Ludwig Wittgenstein. He had a unique way of doing philosophy that exposed “the pathology” embedded in language and conceptions of language, thoughts and emotions, and wanted to cure philosophy of its “illness.” An illness stemming from how we think, especially how we think about “mental” processes and/or objects. As Wittgenstein detailed in his writings, the problem with our thinking is that we’re obsessed with finding causes, correspondences, rules, parallels, generalities, theories, interpretations, and explanations for our thoughts, words and verbal deeds. It gives us “mental cramps” and, in his often blunt way of putting things, he tells us:

There is nothing more stupid than the chatter about cause and effect in history books; nothing is more wrong-handed, more half-baked.

Next, the American philosopher John Searle. In his recent book, Making the Social World: The Structure of Human Civilization, Searle begins:

How, if at all, can we reconcile a certain conception of the world as described by physics, chemistry, and the other basic sciences with what we know, or think we know, about ourselves as human beings? How is it possible in a universe consisting entirely of physical particles in fields of force that there can be such things as consciousness, intentionality, free will, language, society, ethics, aesthetics, and political obligations? Though many, perhaps most, contemporary philosophers do not address it directly, I believe that this is the single overriding question in contemporary philosophy.

Psychologists need to join philosophers like Searle and Wittgenstein in asking this question instead of continuing to function with conceptions and methods constructed upon a foundation of dualistic separations of objective-subjective, physical-mental and body-mind.

Ken Gergen is among the few psychologists who have done so for decades. While I could quote from any number of his books and articles, I want to get back to diagnosis. In 1995, Gergen and Fred Newman presented a paper at APA entitled, “Diagnosis: The Human Cost of the Rage to Order” (published in Performing Psychology: A Postmodern Culture of the Mind.). It’s a polemic against psychological dualism, a critique of dominant views of the vocabulary of mind, an exploration of the philosophical assumptions that underlie diagnosis and the DSM, and a call for the democratization of diagnosis:

Despite all our facetious observations about the more absurd characterizations in DSM-IV, it ain’t funny.  Why? Because in everyday pictorial, identity-theoretic therapy these descriptions (diagnoses) are frequently used to stigmatize, constrain, and punish those to whom they are applied.  We do not change that by any kind of analysis.  We change it only by changing the diagnostic form of alienation: opening up diagnosing to everyone, continuously, although non-referentially and non-judgmentally.  We can all perform diagnosing together.  Not to get it right.  Not to give everyone a chance to do it.  But to create/perform jointly a zone of relational development (if we may take poetic license with Vygotsky’s formulation) in which we can together create new forms of life, new meanings, new lives.”

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.

Please check out the latest issue of the East Side Institute’s newsletter, Reports from the Field, for news on what our friends, colleagues and alumni are up to. You’ll hear from Annalie Pistorius and her new social therapy practice in Pretoria South Africa, the synergy between Elina Lampert-Shepel and Brazilian educators at a Vygotsky research conference, and much more.

Question: What’s it like to participate in an academic conference taking place in China and on the topic of contemporary capitalism?

Answer: An academic conference.

Which is to say that you have to do the work to create human connection/conversation outside the rigid conference structure of one person after another lecturing. It’s hard work, especially when you don’t speak the language of 90% of the participants!  But it’s well worth it in the new friends you make and the new learnings you gain.

The conference banner

This past weekend I was one of four non-Chinese guest speakers (the “Western Marxists”) at the Third International Conference on Contemporary Capitalism Studies in Hangzhou, China.  The sponsors were the Center for Studies of Marxist Social Theory, Department of Philosophy, and School of Marxism at Nanjing University, and the Center for Marxist Studies at Hangzhou University, About 70 people were there in total, “senior” and “junior” scholars, postdocs, and graduate students in philosophy, social theory and Marxist studies. While the presentations were all over the place with regard to topic, the challenge many of the Chinese presentations tried to engage was understanding how China is (and/or should be) facing capitalism: Do Marxian concepts shed some light on this question and, if so, which ones? What role do traditional Chinese values play in China’s growing economy; are they hindering or helpful, both or neither?  Are we witnessing capitalism ‘s (“inevitable”) collapse; if we are, then what’s next?

My presentation, on Fred Newman and the Practice of Method introduced Newman to the Chinese scholars and explicated our development community’s work as the postmodernizing and therapeutization of Marx. The other Westerners—Neil Harding from Wales, David McNally from Toronto and Ian Parker from Britain—introduced new conceptual tools as ways of seeing current class struggle, building socialism and engaging in resistance.

Unfortunately, there was little dialogue that might have led to us creating some new understandings. But informally I had some wonderfully lively and moving conversations with “the younger generation” who were eager to explore what it means to practice method (and not just do theory), to create emotionality, and to build community. Some of these took place at the spectacular West Lake and the park that surrounds it, and at extraordinarily delicious banquet meals.

New Friends Jayson and Lily

From Hangzhou we went to the city of Nanjing, where I led a class for philosophy postdoc students on Marx, Vygotsky, Wittgenstein and Social Therapy. I began with a brief introduction of how I came to Marx, philosophy and therapy as a political organizer (and developmental psychologist). Then I asked them to perform part of the play, “The Myth of Psychology” in which Vygotsky and Wittgenstein are in therapy and talking about Karl Marx. Just as participants in my Thought Leadership of Fred Newman class in NY, those in Nanjing really got into it. They asked how could we speak of fetishization outside of political economy, what Social Therapy looks like, what to do about “objective” unhappiness in the world, and the relationship between changing the world and changing ourselves.

I thank the students for their willingness to create a playful and open learning environment with me and for their great questions. Professor Huaiyu Liu and Dr. Jing Wu  (who translated for me) were fabulous “completers” of my thinking and my English words. All in all, a great time was had by all! I later found out that I had given No. 88 in the Marxist seminar series of the Center for Studies of Marxist Social Theory!

Last week in The Thought Leadership of Fred Newman we played with the Newman play in which Lev Vygotsky and Ludwig Wittgenstein are in therapy with a social therapist (referred to in my last post). I asked folks to break up into four groups and perform the readings of the play in any way they wanted. I said that plays are meant to be performed and that inviting them to perform it together would, I hoped and expected, create an open and creative environment for ensuing conversation. One group broke themselves up into the three characters and commented that it was lovely to hear and relate to multiple Wittgensteins and Vygotskys and Brauns. Another group played with pitch and loudness, and ended with whispering the lines into each other’s ears. There was no shortage of creativity among the groups!

The conversation we wound up creating meandered (my favorite kind) with, in hindsight, a continued focus on what it means to understand and how we create understanding, both as individuals and as a group. Specifically, we spent time speaking about “will” and “motivation” and the activity of doing the unexpected and its relationship to playing like children (what does it mean that, as one participant said, “Everyone was willing to go into the groups and perform”); about reading/performing when you have no idea what you’re reading (the assumption being this is not a good thing, but we questioned that in light of assumptions about what language is); and about the experience of appreciating what they created.

Tonight is the final week. The reading is an article by Newman and Ken Gergen, expanded from an APA presentation the two of them made in 1995. It’s titled, “Diagnosis: The Human Cost of the Rage to Order.” (It’s a chapter in my edited book, Performing Psychology.) I’m looking forward to helping the class with this challenging and important academic piece that argues for a move away from both pictorial and a pragmatic views of language to one of relational activity—and the democratization of diagnosis. Vygotsky and Wittgenstein are, again, characters. As is social therapy, this time with Newman himself.

I was delighted to come across this Amazon reader review of my book Vygotsky at Work and Play. The author is David R. Cross, Ph.D.

Thanks, David!

 A Transformative Book Reflecting on a Transformative Life, July 2, 2011

Every now and then you get lucky, and find the book that is just the book you need at that point in your career to take the next step forward. (I used “book” in this opening sentence, but the same could be said for “article” or “presentation,” but here we are concerned with books.) Lois Holzman’s Vygotsky at Work and Play is just that sort of book. Up until reading it, I had been unaware of Lois Holzman’s work, and this book is a great introduction. It is a kind of intellectual autobiography, a conceptual reflection on her several decades of good work. The book is short, well-written, and a great lead-in to the work Holzman has done, mostly in partnership with Fred Newman. Their work is both multifaceted and highly innovative, and it challenges some traditional conceptions about how science is done. Their work is multifaceted because they have made significant contributions to therapy (social therapy), schooling, out-of-school (youth) programs, and the workplace (organizations). The same conceptual principles underly all of this work, which derive mainly from Vygotsky and Wittgenstein. Their work is innovative for a number of reasons, not the least of which is their methodology. Part of their innovation is their (re)conceptualization of Vygotsky’s “Zone of Proximal Development,” and another part is their emphasis on performance, both as a product and a process of development in context. This is a book worth reading.

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.