The Cult of DSM


Ending Our Allegiance to the Great Gazoo


A client comes to see you. Let’s call him Fred. He tells you he has a dream job, one in which he’s mostly left alone to do what he loves. But there’s a hitch: in order to get paid (which he does, and well), he has to stand in front of a video camera once every hour, raise his left hand, stand on his right foot, and say, “I declare obeisance to the Great Gazoo.” He tells you that he knows the Great Gazoo doesn’t exist. He tells you that he, and all his coworkers, think the ritual is stupid and undignified, and he worries that some day the digital video archive of his hypocrisy will come back to haunt him. He also tells you that he’s appalled at himself, at the ease with which he engages in a pointless exercise purely for the sake of money and then drives awareness of his bad faith out of his mind. “Isn’t this how the worst acts are committed—when people still their consciences to get on with the business of daily living?” he asks himself (and you).

At first, the complaint seems rich, intriguing, even piquant. All the tortured ambivalences of a postmodern life seem captured in his hourly degradation at work. It provides fodder for conversation about his expectation that the world will conform to his needs, his disappointment at finding out that it won’t, the difficulties imposed by his quest for integrity. It gives rise to meaningful talk about the fear of poverty, the cruelties of capitalism, the needless difficulty of our economic lives. You discuss alternatives…

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1 Comment

Friday, March 14, 2014 3:55:14 AM | posted by jeffrey von glahn
A very informative historical review. There's only one tiny part I take exception to. It's the claim that therapy works because of "nonspecific factors—or, to put it more bluntly, through the placebo effect." I don't think the use of "nonspecific" factors in the literature means just a placebo. It also means "common" factors, of which placebo is certainly one. My solution to why therapy is effective - and I mean creating a major change rather than, e.g., the adoption of a different attitude - is what I think of as the unforced activation of the client's emotional experiencing, and where "unforced" means coincident with the support the client receives for his experiencing. The most likely result of unforced activation is an emotional release. When activated in this way, such an experience is therapeutic and NOT re-traumatizing, which I can't find an operational definition of. The forced activation of emotional experiencing, usually occurring outside of session and talked about in a session, is not therapeutic; i.e. leading to major change. A common result of unforced activation is crying, which I think of as psychotherapy's Best Kept Secret because it happens with so many clients and yet the mainstream view totally ignores it and regards it as at best a waste of time and effort. See my article in the May-June 2012 PN on Therapeutic Crying, or any of my articles in PsycINFO. Any aspect of psychotherapy that results in the unforced activation of emotional experiencing I regard as a "therapeutic factor," and which resolves the common-specific factor debate as either one of those factors if used to support the client's experiencing can be a therapeutic factor.

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