Generation RX - The Effects of Capitalism on the Practice of Medicine
Anger vs. Drama

An Open Letter to the DSM-5

Mental health professionals from around the world are signing a petition contesting the proposed changes to the DSM-5, as the medical model of mental illness continues to have its validity challenged.

First, let me preface this conversation with the statement that not every clinician in the field of psychology believes in or practices the "medical model".  Nor is that required by our licenses.  There are practitioners of mental health treatment who refuse to diagnose clients as having a mental illness in order to help them.  Imagine that!  They just help people with their problems without slapping a label on them.

And there are those who follow the medical model.  The "medical model" of psychology posits that abnormal behavior is the result of biological problems and therefore should be treated like a disease - typically with medication.   The medical model tends to view the body as a machine to be repaired in order to conform to what would be considered "normal".  Hmm, who decides what is normal?  And why must someone be labeled "abnormal" before we can help them?   

My point here is to encourage people not to blindly accept the medical model as the only way of looking at mental health issues.  There are other ways of viewing mental health or mental "illness", and many are just as valid as the medical model.  (Stay tuned for a future article.)

Now consider a typical mental health practitioner, completely endoctrinated with the medical model, setting out to treat a patient.  First they must declare the patient abnormal and diagnose the malfunction.  How does a practitioner of the medical model diagnose a patient with a mental health issue?  By turning to the DSM. 

The Diagnostic and Statistical Manual of Mental Disorders is the bible of the mental health field.   It establishes the minimal criteria which must be met before a clinician can diagnose you with a given mental illness.  If you are diagnosed with a mental illness it should be because your symptoms meet the criteria established in the current version of the DSM.  I say "should be" because I see an increasing number of children being diagnosed with and medicated for ADHD as early as 3 years old though the criteria of the DSM-IV TR makes it clear that they were assessing children of school age.  I also see an increasing number of people being diagnosed with and medicated for depression after experiencing a loss though the current version of the DSM requires that depression be excluded as a diagnosis if the symptoms are better explained as bereavement.  

The validity of the DSM has already been called into question by the well documented ties between the pharmaceutical industry and the DSM panel members as early as 2006. Influence from the pharmaceutical industry has put pressure on the psychiatric community to lower criteria standards for many illnesses and to create new ones (i.e. Social Anxiety Disorder) in order to create an even larger market of people who would require their medications.

Objections to the DSM-5 include concerns about:

"the lowering of diagnostic thresholds for multiple disorder categories, about the introduction of disorders that may lead to inappropriate medical treatment of vulnerable populations, and about specific proposals that appear to lack empirical grounding. In addition, we question proposed changes to the definition(s) of mental disorder that deemphasize sociocultural variation while placing more emphasis on biological theory."

This is a serious issue which deserves more attention than it will probably receive.  See the letter in its entirety and consider signing the petition at:  Open Letter to the DSM-5.

Thank you to Dr. Brent Robbins for bringing this petition to my attention.

 

Comments

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Marie Gronley MD

I can understand and appreciate your point which is well made. There does seem to be an increase in diagnosing "mental disorders" as physiologically grounded versus a personality disorder. I would hope that most psychiatrists would use good discernment and not jump to the conclusion that every form of aberrant behavior is due to a chemical imbalance and consider personality disorders along with possible underlying biological issues. Myself and many colleagues make it a point to use a team approach and refer to psychologists and counselors when we believe that an individual would be better served with counseling or a behavior modification opposed to medications.

Kellen

Hello Dr. Gronley,

I wish there were more like you. I do realilze that there are some truly wonderful psychiatrists out there and I have had the good fortune to work with a few of them. But I have also seen the effects of the drug reps on their attitudes and this worries me. I think the tide is turning, however, and recent efforts by the American Psychiatry Association to hold themselves more accountable and to take active measures to reduce the influence of pharmaceutical companies on psychological research and practice is very encouraging and is working to restore people's faith in the psychiatry field.

(If only the banking industry would hold itself up for such scrutiny and work to maintain the same ethical standards!)

I also appreciate your point about the team approach to treating patients. A good treatment team is invaluable to both the clinician and the patient. Thank you for pointing this out.

Marie Gronley MD

You're very welcome Kellen, I enjoyed the article and found it to be of great value!

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