Thursday, 16 February 2012

Criticism of the DSM-5, and why the "middle way" is dangerous

If you're a mental health professional, or in any other way interested in the matter, and you don't want to be regarded backward, if you haven't yet, you better hurry to join in on the criticism of the forthcoming edition of the DSM!

These days, the internet is teeming with DSM-5 criticism, not least by professionals, and to judge from the vast majority of it,  the stance to take is that, this time (as in: opposed to last time), the proposals for new DSM categories are going too far. If the new categories are accepted as valid diagnoses, making their way into DSM-5, this will threaten, and might indeed erode psychiatry's credibility. After all, the proposed new categories aren't sufficiently supported by science, and we don't want anything unscientific in the DSM, do we? No, certainly not. Especially since the initiative for the forthcoming edition of the DSM was taken out of concerns about the lack of science behind the current edition... Oh, wait, that means what's in the current edition, DSM-IV-TR, isn't really backed by science, then? Exactly, that's what it means. And that then means that we protest new categories to go into the DSM, because we don't want them to -- yeah, what? Further add to the load of categories not backed by any science?...

Confused? Well, that's probably because you're still caught up in what commonly is thought of as "logic". Know that psychiatric logic is different . It may seem twisted at first glance, but, if you take a step back, and look at the big picture, it's actually quite simple: we have a number of behavior patterns, recognized by psychiatry as treatable (though not curable), medical conditions, a definition that, for several reasons but scientific ones, has been widely accepted by the public to be scientific -- just like the public once upon a time, for several reasons but scientific ones, accepted as the one and only truth that there is such a thing as spirit possession -- and now the worst we could do is to push our luck, and have this acceptance shaken to its foundation. 

Imagine, if the public started to question the validity of categories like "bipolar", "depression", or "ADHD"! Not to mention that of "psychosis"/"schizophrenia", psychiatry's "holy cow", the category that represents "insanity" in its purest form, and without which psychiatry might just as well pack up, because if the purest form of "insanity" isn't a medical condition, then none of psychiatry's categories is, and there is nothing left for psychiatry to label and treat (but not cure). Imagine, if psychiatry had to pack up, if we no longer could call people for "psychotic killers", with the psychiatric profession's seal of approval, that, miraculously, without any science to back it up, turns ordinary name-calling into, er, evidence-based diagnosis, if we had to acknowledge that we all are just human beings, reacting to life, some more extremely than others, due to more extreme life experiences than others', but still human beings! Imagine, if we couldn't scapegoat at least a certain number of people anymore, if we couldn't blame their faulty genes and brains anymore for our own insufficiencies, as parents, as a society, or as professionals! What a cruel world it would be!

So, if you want to save psychiatry, the "middle way" is the way to choose! Join the American Psychological Association, and "experts" like Allen Frances, Ronald Pies, and all the other hot-shots, including, well, Doug Bremner, and criticise the new categories proposed for the DSM-5, while you, by doing so, additionally confirm the already in the DSM, current edition, listed categories' scientific validity. By all means, don't go too far (!), like the British Psychological Society unfortunately does -- take for instance B 00, Schizophrenia, in their statement: "normal individual variation", "relational context of problems and the undeniable social causation of many such problems", "invalidity of this diagnosis", ... yeah, they're talking about schizophrenia, these guys must have lost it! Or as this and this petition wants you to go!

Certainly, a lot of harm is done to those who are misdiagnosed, and the new categories proposed for DSM-5 open up for more of such harm to be done to more people in the future, but how on earth can a diagnosis harm the person so diagnosed, if the diagnosis turns the person into a non-person? So, "psychosis", "schizophrenia", or whatever else from the DSM-IV: no harm done! Unless you were misdiagnosed, that is...

Sarcasm aside, the current discussion about DSM-5 and the validity of psych labels in general led my thoughts 1 1/2 year back in time, to a comment I received on this post, because it illustrates very nicely what the "middle way" actually looks like. A comment I back then decided not to publish.

The reason I didn't publish the comment in question back then was that I had no doubt that it was written in a state of pain and distress, emotional distress (as in "mental illness", exactly), so I thought, I'd "protect" the author of the comment against himself. This kind of reasoning, of course, is exactly the reasoning the mh system employs to justify its bad habit of regularly depriving labelled people of responsibility for themselves, their actions, their choices, and of their right to be heard. I put myself into the position of the one who knew what was good for the author of the comment, and although I still think the choice I made back then on behalf of the author was a wise one, I also think I was compromising myself by thinking I was in a position to choose on his behalf. I was infantilizing the author, "parenting" him, just like mh professionals usually do with those they've labelled "insane". "Do not parent. Parenting keeps kids alive and adults insane." -Peter Bullimore. "Insanity" means not having been given the chance to make one's own choices and take responsibility for them. No one can grow up and become "sane", as long as they're continuously denied the chance to make their own choices and take responsibility for them. So, I'm going to publish the comment below, as a sceen shot of the email notification I received back in 2010, since I, unfortunately, have deleted it from my comments folder at Blogger.

I am aware that the comment can be damaging to its author. It is for instance clearly a violation of the APA's Principles of Medical Ethics, section 7, item 3, and since it would have been possible for its author to remove it any time from the comment section at the post, while it is not possible for him to remove the screen shot here, I will of course do so, if asked to (in a commonly polite manner, any further abuse will be ignored, thank you!).

Anyway, this is what the "middle way" looks like: