04 May Therapy Today Weighs in on DSM-5
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.”
loisholzman
Posted at 22:39h, 06 MayThanks so much for your comment! What you say is so important and so strikingly common sense, the way that breaking our of a particular way of seeing can be! I and my readers would love to hear more.
Neil Samuels
Posted at 00:56h, 06 MayWith respect to the note on the “Autism epidemic”, as a Developmental special educator who works with families in the Early Intervention (0-3 yrs) population I have seen so many cases over the course of the last 10 years entirely and egregiously misdiagnosed. Partially, this has been due to the inability of caregivers and clinicians to understand how to convey (on a preverbal level) affective meaning and socially connect with the child’s underlying affective sensory-motor processing differences (e.g., visual-spatial, proprioceptive, vestibular, tactile). Also, there is the critical challenge of how to understand the roles of the primary caregivers’ affective dynamics with their child’s differences. A primary caregiver (or clinicians) can be under-responsive or over-responsive to their child’s perseverative or stereotypical behaviors and further exacerbate the severity of the child’s “pathology.”
However, once developmental pediatricians, clinicians and primary caregivers can learn how to slow down, watch, wait and listen and, in turn, (deepen) dyadic affective attachment we begin to see meaningful social changes in the child’s externalized “presenting behaviors.” For example, when I and colleagues go to or guide others to go half-way to the child’s world, mirror/reflect do what s/he is doing (with reassuring inflected tonal qualities of voice – in accordance to that particular child’s affect style) a preverbal co-narrative “meaning-making process” begins to become viably established (felt from the child’s perspective). We then begin to (creatively add) add meaningful slight (affective) variations. Essentially, what we are doing is beginning to create and extend a new “social co-narrative meaning-making process” – that is, in a manner that is Meaningful and suited to the child underlying affect-emotional processing differences. At this point we begin to see clinically meaningful (measured) simple to increasingly complex two-way reciprocal emotional problem solving. The child begins to separate “ideas” from fixed modalities or perception; language begins to emerge, etc .
Recently published (2012) clinical trials from University of Toronoto (MEHRI foundation) using a social-relationship (DIR/Floortime based approach) has begun to unequivocally demonstrate clinically significant and clinically meaningful manner the resulting neurophysiological accompanied changes (e.g., a deeper synaptic connectivity and synchronization between the prefrontal cortex or the executive functions and the limbic system, the All or nothing responses of the amygdala).
I am making twos points here. Firstly, by primary caregivers and clinicians learning how to learn to slow down and “socially-emotionally connect ” with a child’s underlying neurodevelopmental affective differences we begin to deepen or re-establish the bonds of dyadic reciprocal attachment. We are specifically doing this by attributing (and having primary caregivers attribute) Affect/Meaning to the child’s “current surface behaviors” as they are indeed meaningful to him/her (however, they are otherwise commonly regarded purely on a social neurotypical stereotypical surface; ipso facto, in turn, perceived as “inappropriate”; drilled by ABA, applied behavioral analysis or Cognitive behavioral methods into submission and for “good measure” further imprisoned/lobotomized depending on perceived insult with the administration of psychotropics – and of course tremendous profit!)
Secondly, the classificatory allowance of PDD-NOS and Aspergers as part of (or now one with in DSM-V) as ASD is entirely wrong. In many ways, and it is too long to go into here ,we are severely and egregiously in many cases not all pathologizing genius. Einstein and many artists, poets and technological geniuses would today as children be promptly and dutifully medicated for their “aberrant unbecoming.”