TALKING ABOUT THE DSM – ITS INFLUENCE AND OUR RESPONSES

TO IT

Presentation to the Therapeutic Conversations X Conference

Vancouver, May 12, 2012

Tom Strong, University of Calgary

AMERICAN PSYCHIATRIC ASSOCIATION DSM-5 DEVELOPMENT

DSM-5: The Future of Psychiatric Diagnosis

Publication of the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in May 2013 will mark one the most anticipated events in the mental health field. As part of the development process, the preliminary draft revisions to the current diagnostic criteria for psychiatric diagnoses are now available for public review. We thank you for your interest in DSM-5 and hope that you use this opportunity not only to learn more about the proposed changes in DSM-5, but also about its history, its impact, and its developers. Please continue to check this site for updates to criteria and for more information about the development process.

From the DSM-5 website  http://www.dsm5.org/Pages/Default.aspx

WHAT’S GOES IN/INTO A LABEL?

SOME RECENT DSM HEADLINES

DSM: Diagnosing for Money and Power DSMV Revisions Erupt in Controversy Wrangling over psychiatry's bible DSM-V Psych Bus hits more big potholes;

passengers bail It's not too late to save 'normal‘ DSM-V: a medical minefield The Epidemic of Mental Illness: Why? Psychiatry's civil war Inside the Battle to Define Mental Illness A Most Dangerous Manual

WHY CAN’T THERE BE LOCAL DX?

DSM and its parasitic discourses of administration, Pharma, professionalism, etc.

The DSM’s logic to those embracing it

Language as an elusive means of ‘getting a handle’ on the emotional and inchoate.

WHY THE DSM-V MIGHT MATTER TO YOU

It is increasingly used to administer, ration and regulate therapeutic practice

WHY THE DSM-V MIGHT MATTER TO YOU

It medicalizes and internalizes what clients and you might externalise and problem solve

WHY THE DSM-V MIGHT MATTER TO YOU People increasingly

self-identify using DSM labels, while fighting the stigma associated

WHY THE DSM-V MIGHT MATTER TO YOU There are more

discourses of help-seeking and help-offering than brain and symptom-based ones

WHY THE DSM-V MIGHT MATTER TO YOU It eclipses clients’

resources and resourcefulness

SCIENCE & THE IMPULSE TO NAME & CLASSIFY

Promises of modern science

Human science as different from studying rocks & trees

Descriptions as prescriptions?

Vico on common sense, linguistic poverty & poetic wisdom

Deleuze on repetition & discursive capture

WITTGENSTEIN ON ‘CORRECT’ AND MULTIPLE LANGUAGES

Single idealized & systematized logical language

Abstract concepts to guide actual interaction

Everyday languages

‘Language games’

FOUCAULT’S GENEALOGY OF MADNESS Michel Foucault

DSM-V: GETTING CLOSER TO PATHOLOGIZING EVERYONE?

THE DSM & EBP COUPLING? Diagnoses & Intervention Evaluation research

Studying therapeutic interventions as drugs?

Questions and responses as interventions?

‘Algorithms’ of practice?

What about PBE (Practice-based evidence)?

CONCERNS FROM THE CHAIRS OF DSM III & DSM-IV

Robert Spitzer, MD Allen Frances, MDhttp://www.psychiatrictimes.com/dsm-5

INSIDE THE DSM COMMITTEE PROCESS

Paula Caplanhttp://www.psychdiagnosis.net/

BIG PHARMA & DSM-V?

Dr. Marcia Angell – Former Editor of the New England Journal of Medicine

NY Review of Books http://www.nybooks.com/articles/archives/2011/ju

l/14/illusions-of-psychiatry/

http://www.nybooks.com/articles/archives/2011/jun/23/epidemic-mental-illness-why/?pagination=false

DSM STUDY (STRONG, GAETE SILVA, SAMETBAND, FRENCH & EESON, 2012)

Online survey of over 100 therapists on how they are influenced by DSM & how they respond to DSM.

11 in-depth interviews

Online blog

Analysing for multiplicity

Discursive positions and tensions between them

e.g., the up and downsides of DSM diagnoses.

NATURAL ORDER TO BE DISCOVERED?

MESSINESS TO INTERPRET SOMEHOW?

MAKING SENSE OF ALL OF OUR DATA?

SOCIAL ARENA: DISCURSIVE COMMUNITIES & ACTORS

RELATIONAL MAP (SIMPLIFIED)

POSITIONAL MAP: CREATIVE RESPONSES

MOVING BETWEEN MANY DSM POSITIONS?

Discursive positioning and positioning calls.

Negotiating the acceptably famliar

Strategic uses of the DSM

Keeping things discursively flexible.

POLITICAL RESPONSES

Open Letter to the DSM-5 /petition:

http://www.ipetitions.com/petition/dsm5/

David Elkins, APA’s Division of Humanist Psychology

Opposed by 10 Divisions of APA, BPS, ACA, Scientific American, AFTA, etc…..

CONVERSATIONAL RESPONSES

Go inside the dx and discuss its adequacy as a total description

Supplement the dx discourse with at least 1 non-symptom discourse

Externalize & contextualize what is internalized by the dx

Strengths & resourcefulness dx – identify symptoms of solution (Miller, 1992)

Share the professional & scientific controversies about the DSMV

Partnering with one’s medications?

THANK YOU

For further information: strongt@ucalgary.caWebsite: http://www.ucalgary.ca/strongt

Joaquín Gaete SilvaTom Strong

Jen EesonJared French

Inés Sametband

YOUR TURN TO TALK

FURTHER READINGAmerican Psychiatric Association (nd) DSM5 website: http://www.dsm5.org/Pages/Default.aspx Angell, M. (2011, July 14). The illusions of psychiatry. The New York Review of Books. Retrieved from:

http://www.nybooks.com/articles/archives/2011/jul/14/illusions-of-psychiatry/?pagination=falseCaplan, P. J. (1996). They say you’re crazy: How the world’s most powerful psychiatrists decide who’s

normal. New York, NY: Da Capo Press. .Cooper, M., & McLeod, J. (2010). Pluralistic counselling and psychotherapy. London: Sage. Cushman, P. (1995). Constructing the self, constructing America: A cultural history of psychotherapy. New

York, NY: Perseus. Danziger, K. (1997). Naming the mind: How psychology found its language. London: Sage. Eriksen, K., & Kress, V. E. (2005). Beyond the DSM story: Ethical quandaries, challenges, and best practices. Thousand Oaks, CA: Sage Publications, Inc. Frances, A. (2012, February 21) DSM 5 freezes out its stakeholders. The Huffington Post. Blog commentary

retrieved online from: http://www.huffingtonpost.com/allen-frances/dsm-5-freezes-out-its-sta_b_1269838.html

Gergen, K. J. (1990). Therapeutic professions and the diffusion of deficit. Journal of Mind and Behavior, 11, 353-368.

Greenberg, G. (2010). Manufacturing depression: The secret history of a modern disease. New York: Simon & Schuster.

Grob, G. N. (1991). Origins of DSM-I: A study in appearance and reality. American Journal of Psychiatry, 148, 421-431.

Hacking, I. (1998). Mad travelers: Reflections on the reality of transient mental illness. Cambridge, MA: Harvard University Press. House, R. (2005). Therapy beyond modernity: Deconstructing and transcending profession-centred

therapy. London: Karnac. Miller, S. (1992). The symptoms of solution. Journal of Strategic & Systemic Therapies, 11, 1–11. Rapley, M., Moncrieff, J., & Dillon, J. (Eds.) (2012). De-medicalizing misery: Psychiatry, psychology, and the

human condition. New York, NY: Palgrave Macmillan.Strong, T., Gaete Silva, J., Sametband, I, French, J., & Eeson, J. (2012). Counsellors respond to the DSM-IV-

TR. Canadian Journal of Counselling and Psychotherapy, 46(2), 85-106.Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.