More on The DSM-5 Controversy

09 Jan More on The DSM-5 Controversy

January 9, 2012

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.”