Challenging the Cult of DSM
What Would Happen if We Stopped Playing the DSM Game?
There has been no more withering and hilarious critique of the entire DSM enterprise than The Book of Woe: The DSM and the Unmaking of Psychiatry. Its author, Connecticut psychotherapist Gary Greenberg, has been described as “equal parts Woody Allen, Kierkegaard, and Columbo.” Greenberg has dedicated himself to exposing the political in-fighting, hypocrisy, and lack of scientific validity at the heart of the diagnostic system, what his recent article in the Networker described as “The Cult of DSM.” As he put it, “Finding someone who thinks the DSM is of clinical value is like walking around Athens with a lamp lit in the daylight looking for an honest man.”
There’s something both startling and refreshingly direct about hearing Greenberg’s no-holds-barred denunciation of the very idea of psychiatric diagnosis. “To diagnose people is to hide uncomfortable truths about what we do, why we do it, and how we get paid for it,” he claims. “Abandoning diagnosis, and with it the bacteriological model, would no doubt induce confusion and maybe even chaos among us therapists, even as it reduced our income and status. But that’s often the price of honesty. And I would point out that if there is one profession suited to tolerating the difficulties of the truth, it’s ours.”
This video clip gives you the flavor of one of Gary’s scathing, wildly entertaining riffs on DSM-5. But ultimately, what’s so compelling about Gary is his willingness to challenge us to take responsibility for going beyond the limits of DSM and envision what the alternative to it might be. As he states in his Networker article, “I think it would have to have an explicit social dimension, one that included justice and fairness and other moral considerations normally held to be outside the bailiwick of medicine… And it would have to include a definition of wellness and even flourishing, and some agreement about which conditions that fall short of those qualities are deserving of our collective resources.”
You can learn more about Gary’s call to action in the Networker Webcast series, The Uproar Over DSM-5.
The Uproar Over DSM-5
How to Use the New Standards with Confidence
Click here for full course details
Topic: Business of Therapy
Tags: Diagnostic and Statistical Manual | diagnostic system | DSM | dsm-5 | fighting | Gary Greenberg | psychotherapist | therapists
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5 Comments
Tuesday, May 27, 2014 7:59:17 PM | posted by mrsportpsych
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Tuesday, May 27, 2014 7:13:05 PM | posted by daisy swadesh
Your comparing a person to a quantum particle gives an extraordinary insight--despite the obvious and enormous differences between a human being and a subatomic particle, the similarity between not knowing what a person is except by how they interact with another person is very real. People in positions of power tend to not notice this because they don't have to adjust to another person as a reality. But people having less power, especially counselees, students and children, are intensely aware of how different they can be depending on whom they are interacting with and what the other person allows to happen between them.
Tuesday, May 27, 2014 6:54:22 PM | posted by daisy swadesh
Thank you, Gary, for saying it like it is! But how long does a paradigm shift take?
The CDC (Center for Disease Control) recently declared that, "child maltreatment [is] a serious public health problem with extensive short- and long-term consequences."*--and is writing on various aspects of it. It's an effective end-run around the APA's continued refusal to address Developmental Trauma.
Now that it's been recognized by such an influential public institution how long will it take for this to percolate down to physicians, hospitals, the courts and every individual and organization involved in the diagnosis, treatment and decision-making on the lives of children and ADULT survivors for whom interpersonal trauma interfered with their normal and healthy social and emotional growth?
I have witnessed the 30-year battle of Catholic families for the recognition of child molestation by priests by the Catholic hierarchy. The APA--(psychiatrists)--has been involved in a similar cover up. Breaking through that institutionalized system of denial is but one aspect of change needed. Rehabilitation methods for adult survivors and Prevention through good parenting are two other essentials that need to be addressed.
The CDC (Center for Disease Control) recently declared that, "child maltreatment [is] a serious public health problem with extensive short- and long-term consequences."*--and is writing on various aspects of it. It's an effective end-run around the APA's continued refusal to address Developmental Trauma.
Now that it's been recognized by such an influential public institution how long will it take for this to percolate down to physicians, hospitals, the courts and every individual and organization involved in the diagnosis, treatment and decision-making on the lives of children and ADULT survivors for whom interpersonal trauma interfered with their normal and healthy social and emotional growth?
I have witnessed the 30-year battle of Catholic families for the recognition of child molestation by priests by the Catholic hierarchy. The APA--(psychiatrists)--has been involved in a similar cover up. Breaking through that institutionalized system of denial is but one aspect of change needed. Rehabilitation methods for adult survivors and Prevention through good parenting are two other essentials that need to be addressed.
Tuesday, May 27, 2014 6:44:19 PM | posted by Lynn Johnson
Good discussion; the next step is to see what effect one diagnosis or another has on the actual treatment. I predict:
- good therapists, the diagnosis has no effect, since what we treat is not a disorder but rather a person-in-the-world.
- pseudoshrinks: the diagnosis will make a lot of difference, because the poorer therapists (not $$ but impact) aren't relating to the client as a person.
Psychoanalysis, solution-focused therapy, many versions of family therapy, and positive psychotherapy all have on thing in common: No interest in diagnosis. We "treat" clients by interacting with them here-and-now, offering unexpected and surprise responses (what Ernst Beier long ago called the "paradigmatic response") and giving directives to change between-session behavior. None of that can be predicted by diagnosis.
- good therapists, the diagnosis has no effect, since what we treat is not a disorder but rather a person-in-the-world.
- pseudoshrinks: the diagnosis will make a lot of difference, because the poorer therapists (not $$ but impact) aren't relating to the client as a person.
Psychoanalysis, solution-focused therapy, many versions of family therapy, and positive psychotherapy all have on thing in common: No interest in diagnosis. We "treat" clients by interacting with them here-and-now, offering unexpected and surprise responses (what Ernst Beier long ago called the "paradigmatic response") and giving directives to change between-session behavior. None of that can be predicted by diagnosis.
Tuesday, May 27, 2014 3:16:46 PM | posted by Ray McKinnis
Gary Greenberg's comments could not have come to me at a better time. Last week I made a major decision (because of many of the dynamics Gary articulates) to no longer try to develop a counseling practice (after 6 years) but to go back to being a clinical statistician and pursue my counseling passion in other ways (like volunteering at a local jail to facilitate a group of inmates with substance abuse issues--no lying to insurance companies; no inappropriate diagnosis or treatment plans; only what works as we work together to help them become 'free') and by writing.
I find the definition of a quantum particle very helpful as an alternative definition of a personality--it is a bundle of indefinite statistical possibilities any of which are actualized only when it encounters another particle or field. Thus each of us has an innumerable possibilities--probably most of those listed in the DSM 5 depending on who or what we are relating to. Any 'diagnosis' or treatment plan must consider the dyad 'client-counselor' and realize that what personality attributes a client 'actualizes' as they relate to me depends in part on who I am and what parts of myself I actualize in that situation. I'm writing a book beginning with that way of approaching psychology and counseling. After finishing it, I should know better what I believe to be true and helpful.
I find the definition of a quantum particle very helpful as an alternative definition of a personality--it is a bundle of indefinite statistical possibilities any of which are actualized only when it encounters another particle or field. Thus each of us has an innumerable possibilities--probably most of those listed in the DSM 5 depending on who or what we are relating to. Any 'diagnosis' or treatment plan must consider the dyad 'client-counselor' and realize that what personality attributes a client 'actualizes' as they relate to me depends in part on who I am and what parts of myself I actualize in that situation. I'm writing a book beginning with that way of approaching psychology and counseling. After finishing it, I should know better what I believe to be true and helpful.
