The American Psychiatric Association’s DSM-5 Task Force has projected publication of the APA’s new Diagnostic and Statistical Manual of Mental Disorders for May of next year, three years later than originally anticipated. The fifth in a series of revisions dating back to the publication of DSM-I in 1952, DSM-5 is proving to be the most controversial since the landmark DSM-III, published in 1980. The latter was noteworthy for expunging all psychoanalytic concepts from its 265 diagnostic categories and postulating a neurobiological model for understanding and treating all mental illnesses; consequent to which, psychiatrists were established at the top of the hierarchy of mental health practitioners and psychoactive medications became incorporated as the essential element in treating mental illness.
Despite protests from various researchers, these fundamental clinical and political shifts in the mental health field have become fully accepted by its principal stakeholders – all levels of government; private insurance companies; practitioners and their agencies; families and patients. The DSMs in their several revisions – IIIR in 1987; IV in 1994; IV TR in 2000 – have sold millions of copies and affect the lives of millions of practitioners and patients the world over.
The APA’s stated intent for the DSM-5 is to expand the scientific basis for psychiatric diagnosis and classification. In pursuit of that goal, the DSM-5 Task Force appears to have stirred up new questions concerning the pre-eminence of the biomedical model, of psychiatry and the use of psychoactive medications and mental health treatment in general. Witness Benedict Carey’s two articles on the front pages of The New York Times this past January describing two draft diagnostic revisions put forward by the Task Force. The first concerned the proposed narrowing of the autism spectrum and the consequent denial of treatment and insurance benefits to affected children and their families, and the second the inclusion of grieving, previously excluded, as a criterion for the diagnosis of Major Depression.
As early as the middle of last year, the first draft revisions published on the Task Force’s website, DSM-5 Development (www.DSM5.org), drew strongly worded protests from the American Psychological Association, the British Psychological Association and the American Counseling Association (ACA). Their principal concern centered around the lowering of diagnostic thresholds, which the American Psychological Association (APA) characterized as “… scientifically premature and holds numerous risks … [that] increasing the number of people who qualify for a diagnosis may lead to excessive medicalization …” [and increased prescription of psychoactive medications with all their attendant risks.] The APA and the ACA appended a petition to their “Open Letter to the DSM-5” calling for a delay in the publication of DSM-5 and the organization of a multi-disciplinary committee to review the Task Force’s proposed revisions. To date, over 11,000 professionals and professional organizations have signed. Both the “Open Letter” and the petition can be found at www.ipetitions.com/petition/dsm5/.
Perhaps the most heated criticisms have come from Allen Frances, noted psychiatrist and head of the DSM-IV Task Force, who periodically posts blogs about the DSM-5 on his website, http://1boringoldman.com, on Psychology Today (www.psychologytoday.com/experts/) and Psychiatric Times (www.psychiatrictimes.com/blogs/). One of his recent “1 boring old man” posts was titled “Is DSM 5 a Public Trust or an APA Cash Cow?” (1/3/12); and to quote from his Psychiatric Times post of 11/4/11 entitled “Why Psychiatrists Should Sign the Petition to Reform DSM-5”:
“… But what is the most compelling reason for signing the petition to reform DSM-5? This is easy. Our first responsibility is to DO NO HARM!!! [Caps and exclamations Dr. Frances’s not mine.] DSM-5 will do grave harm to the people who are misdiagnosed and often receive unnecessary medication …”
Interestingly, and unless you count blogs I posted on the subject last November and in January at Behavioral Healthcare (www.behavioral.net), I haven’t seen any social workers expressing opinions pro or con on the new DSM and no social work organization has endorsed the APA/ACA petition. Social workers are the single largest cohort of mental health practitioners in the country and we and our clients will all be affected if and when DSM-5 is published. Fortunately, there is still time. The Task Force will sponsor a final two-month online public feedback period beginning sometime this Spring, affording all who wish a chance to voice opinions. Log on periodically to the Task Force website (www.DSM5.org) to determine when the feedback period commences as well as to learn about the Task Force’s objectives and work to date. Also check out the “Open Letter” which, at nine pages, contains a comprehensive and thoughtfully formulated critique of the new DSM. In short, inform yourself. Check out the websites I’ve scattered throughout this article for just that purpose. If you difficulty accessing any of the foregoing, feel free to e-mail me at firstname.lastname@example.org.
Finally, if the “Open Letter” makes sense to you, sign the petition and contact and urge the NASW – City, State and National – to sign it as well.
To quote my old friend, Joe Hill, “Don’t mourn, organize!”
Bentall, R., Madness Explained: Psychosis and Human Nature, Penguin Books, London, 2004
Kirk, S.A., Kutchins, H., The Selling of DSM: The Rhetoric of Science in Psychiatry, Aldine de Gruyter, New York, 1992
Mosher, L.R., et al, “Drug Companies and Schizophrenia: unbridled capitalism meets madness”, in Read, J., Mosher, L.R., Bentall, R., eds., Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia, Routledge, London & New York, 2004
Dr. Carney is a practicing social worker with 42 years of experience in the field. He is an Alinsky-trained community organizer, Institute-trained in Bowen Family Systems theory, and trained in Linehan’s Dialectical Behavior Therapy. He received his MSW from UCLA in 1969 and his DSW from CUNY in 1991.
He recently retired from FEGS, a large New York social welfare agency, where he served as director of the agency’s case management programs in New York City for seventeen years. At present, his professional activities revolve around his private psychotherapy and consultation practice and to writing. He has begun writing a memoir, which he has titled, at least for now, “Good-bye to Mental Health: A Not So Fond Farewell.” He also blogs regularly at www.madinamerica.com.
He lives in Brooklyn with his wife of thirty-one years, and spends his summers in their Adirondack camp in Long Lake, New York.