By Don Laird, MS, NCC, LPC
Some years ago, I was working as a novice therapist at an inpatient psychiatric facility. One morning I entered the room of a male patient who had been admitted a few weeks prior. He had been diagnosed with a severe psychotic disorder. Singing sea shanties, and wearing a makeshift hat on his head, he was standing at attention on his bed.
I approached the bed and said, “Tell me the name of your ship.” He stopped singing, stared at me for a moment, and with extreme annoyance said, “It’s my bed, jackass.”
Over the years I have had many encounters with sloppy postulations. It is one of the many occupational hazards a therapist may find him- or herself stumbling into. Presuming knowledge of a person’s intent is a guaranteed way to misunderstand the situation and possibly contaminate or destroy a relationship. This is what makes the publication of the Fifth Edition of the American Psychiatric Association’s Diagnostic Statistical Manual (DSM 5) so puzzling. There have been four previous editions, beginning with the DSM 1 in 1952, but they claim this one will “be different.” More humanistic, proponents say. In step with comprehensive diagnostics and a response to rapidly developing epidemiology, they say. When more than 50 mental health groups requested independent evidence-based reviews of the new proposals in DSM-5, the APA refused.
“Trust us, we’re professionals. We’re not like the others.”
Let me make this clear before anyone reaches for their torch and pitchfork – I do not completely reject the DSM-5, but I have major concerns. I am not entirely opposed to psychiatry, but I have MAJOR concerns. This could be the subject of an entire tome, but I do not wish to tire you with all my ramblings and late night worries. I have many friends and colleagues who are practicing psychiatrists, psychologists and therapists. Most agree that the new DSM is much of the old served on an appealing platter.
What I challenge here is the specific reliability, validity and usefulness of the new DSM-5. There are many reasons, but my chief complaint is a similar one that I have for any attempt to label others. Labels are applicable with most objects. With people (who are not objects in spite of psychiatric intrusion), labels are dangerous and abusive. As clinicians, we have a responsibility to serve people, not pharmaceutical or insurance companies. This is nothing new – do no harm. Labels harm. They assume and they create a wall between us.
For any discipline or research to be scientific, there are certain basic rules to follow. These rules tell us where we can investigate, and what procedures and measurement tools are suitable. In science, there is no such thing as the last word.
However, the APA leadership has been portraying any opposition against DSM-5 as a form of anti-psychiatry and anti-science. This is simply not true. Psychiatrist Allen Francis states in his new book, “Saving Normal,” that the DSM 5 will “mislabel normal people, promote diagnostic inflation, and encourage inappropriate medication use.” In short Dr. Francis is saying: that is not science, and I concur.
Big Pharm 1 – People 0
My fear (and it is certainly not a new or original one) is that the DSM-5 will lead to unnecessary diagnosis, unneeded prescriptions, and a new pathology to forms of behavior that for the longest time have been perceived as normal human reactions to stressful or tragic situations – such as grief and loss or life transitions. Further, the DSM-5 like its predecessors may generate false outbreaks of pathology and lead to inappropriate drug prescriptions, which could turn out to be harmful. Children are particularly at risk with youthful quirks all but collected into clinical symptoms.
The new DSM is not new science. Psychiatry and psychology are soft sciences at best. Individuals cannot be quantified. You cannot measure human emotion, and certainly judging others by their behaviors is a colossal error.
I often think of the individual I misjudged for a ship’s captain. I wonder where he is today. I have severe doubts concerning the system that was, and perhaps still is, responsible for his “treatment.” I thought he was a seaman based on a presupposition. I can only hope that he has found more understanding and safer harbors since.
In Good Health,