Tuesday, 21 February 2012

DSM 5 - it's all medicalized now

One vocal critic of the DSM-5 bereavement issue is Allen Frances, MD. He has been blogging for some time that the 'mission creep' of the DSM has slipped out of control.
He speaks from experience, as a member of the task force that worked on DSM-IV.

So, why the 'mission creep'? How come the DSM's land-grab in the world of psychic difficulty has extended so far? Here in the UK I would expect the average Daily Mail reader to voice the (reasonable) suspicion that 'someone somewhere is making money out of it'. Perhaps - after all, the production, publishing, and distribution of the DSM is a high-value business. Most successful businesses need to update their stock from time to time - keep the customers interested. Offer a 'new, improved' version of the old product, and suddenly you have a new revenue stream.... for the APA - and oh, lest we forget - for the drug companies who will no doubt profit hugely from the new avenues of prescribing that are offered.

But I don't think for a second that it's just about the money. I think it's also about power and control. In the face of human suffering or distress, the medical model usually responds with an effort to contain or remove it.... diagnose, treat, cure. One could see this as a way of defending against the (more difficult?) reality that life is tough, and sometimes awful, and not always can we do anything about it. As existential psychotherapist Irvin Yalom said, "the medical model is a wafer-thin barrier against uncertainty".
One suggestion to add, then - DSM-x (I'm adding an algebraic symbol here, as I am assuming the revisions will continue....) is revamped time after time, to give the APA further reassurance that they have the power over all these individually classified sufferings. The mission-creep into territory that is NOT mental illness, but represents genuine and normal human life, serves to add to the fantasy of control - we can even help with this horrid stuff too, you see.

The idea that we could (or should) try to map all the ups & downs of the human psyche seems a bit grandiose to me, actually. We mapped the human genome, which has had some useful implications, but we still know that there are huge complexities and gene interactions that we have yet to fathom. So it is with our internal world. Why assume that we can solve all the mysteries?


Monday, 20 February 2012

DSM 5 - Some thoughts.....

I see that a major journal of the medical establishment has spoken out about the American Psychiatric Association's new revision of the "Bible" - the DSM.
An article in the Lancet questions the rationale for removing the 'exclusion' of bereavement.

This exclusion, at present, draws a distinction between those who are suffering grief from an understandable recent loss, and those who are clinically depressed. In my view, this is an important boundary to maintain, for two reasons:

1. People who are suffering from a normal grief reaction aren't normally helped by being told they have some kind of disorder

2. Medics need to be reminded sometimes that there is a difference between a normal emotional reaction and a 'disorder'. See my comments on this in the palliative care field

There was some reaction from the President of the APA, Dr John Oldham. I'll offer some thoughts on his statements later.