University

05/06/2011

You can't diagnose a mental disorder the way you fix a toaster - but the DSM keeps trying

Cover_of_Diagnostic_and_Statistical_Manual_of_Mental_Disorders It’s been a busy for the manual of mental disorders.

A new organizational framework was announced for the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Published by the American Psychiatric Association, it’s the book doctors look at to decide if you’re crazy and what medicine to prescribe for it.  It may or may not be accurate – but it’s a big deal. 

The newest version, now scheduled for May 2013, is proposing to restructure previous categories and chapters to reflect scientific advancements and hypothesized. 

Sounds good, but there’s one big problem:  the DSM has always been flawed, and the proposed DSM-5 looks to be no better.

The flaw is that it tries very hard to figure out symptoms, but no time at all trying to understand people. 

There’s no empirical validation to this approach … and it’s packed with conflicts of interest to the drug companies who benefit each time a new symptom is deemed “treatable” by drugs.    

In direct criticism to the flawed “empirical approach” of the current and upcoming DSM, noted author and psychologist G. Kenneth Bradford states, “Any diagnostic approach based on the objectivizing principles of empirical science is found to be both ontologically and epistemologically unable to account for the complexity of human subjectivity/intersubjectivity. A revisioning of psychological diagnosis according to specifically human scientific criteria is called for…”  In his article, Fundamental Flaws of the DSM: Re-Envisioning Diagnosis, G. Kenneth Bradford expounds upon the provisions necessary to make the DSM a human science based, phenomenological, holistic approach to diagnosis.

Here’s some of what is suggested:

Moving Toward Process Based Psychological Care and Psychiatric Diagnosis: Current diagnosis in the DSM is based largely on static and discrete content. This is inherently flawed based on the observable understanding that human consciousness has the capacity to be free flowing, adaptive, change-oriented and versatile in daily existence. Given this, psychiatric diagnosis and psychological care need to be rooted in a process based paradigm; seeing the human person as a “work in process” capable of change and transformation.

Moving Toward Intersubjectivity in Psychological Care and Psychiatric Diagnosis:  Current diagnosis in the DSM is declared as objective. This flawed perception detracts from the natural intersubjective nature of human beings; the connection and encounter that inevitably happens with two human beings; most especially in the therapeutic encounter. This recognition sees therapeutic diagnosis as taking place in an environment where the therapist is affected by the client (through intersubjectivity) and personal experience which can effect what symptoms are “seen and unseen” in the diagnostic process. Secondarily, psychiatric diagnosis needs to recognize the intersubjective nature of the encounter of patient and mental health professional; and the power that the interpersonal exchange holds.

Moving Toward Greater Freedom in Psychological Care and Psychiatric Diagnosis:  To an extent, current diagnosis is based on prediction and control of the human brain; where very little definitive etiology exists. Human beings are inherently social creatures who exist in a biopsychosocial framework. Current DSM revisions are becoming entrenched in “prediction and control” and away from the openness, responsiveness, and consciousness of the human psyche; which ultimately improve a person’s capacity to be fully alive and fulfilled.  

These are but a glimpse of what is needed to make a diagnostic manual more humanistic and holistic—one that serves the people it was intended to.

As mental health professionals, those being served, and those with invested interest—let your voices be heard, psychiatric diagnosis must be grounded in the reality of human existence.

-- Liz Schreiber

Posted at 05:16 AM in

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