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Response to the American Psychiatric Association: DSM-5 Development - Page 2 - WhatCausesMentalIllness.com
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Login

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It is as if my life were magically run by 2 electric currents: joyous positive and despairing negativewhichever is running at the moment dominates my life, floods it.
Sylvia Plath, journal
   

FAQ  


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Strict Standards: Only variables should be assigned by reference in /home/billbmn/public_html/wcmi1/administrator/components/com_sef/classes/seftools.php on line 949

Strict Standards: Only variables should be passed by reference in /home/billbmn/public_html/wcmi1/components/com_sef/joomsef.php on line 378

Strict Standards: Only variables should be assigned by reference in /home/billbmn/public_html/wcmi1/components/com_sef/sef.ext.php on line 68

Strict Standards: Only variables should be assigned by reference in /home/billbmn/public_html/wcmi1/components/com_sef/joomsef.php on line 1527

Strict Standards: Only variables should be assigned by reference in /home/billbmn/public_html/wcmi1/components/com_sef/sef.router.php on line 115

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Word Cloud  


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Latest Additions  


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Criticism of the 'Mental Illness' paradigm


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Not Illness?

Why Not Call it an Illness? - Response to the American Psychiatric Association: DSM-5 Development

Details

British Psychological Society's Response to the American Psychiatric Association: DSM-5 Development

The Society is concerned that clients and the general public are negatively affected by the continued and continuous medicalisation of their natural and normal responses to their experiences; responses which undoubtedly have distressing consequences which demand
helping responses, but which do not reflect illnesses so much as normal individual variation.


We therefore do welcome the proposal to include a profile of rating the severity of different symptoms over the preceding month. This is attractive, not only because it focuses on specific problems (see below), but because it introduces the concept of variability more fully
into the system. That said, we have more concerns than plaudits.


The putative diagnoses presented in DSM-V are clearly based largely on social norms, with 'symptoms' that all rely on subjective judgements, with little confirmatory physical 'signs' or evidence of biological causation. The criteria are not value-free, but rather reflect
current normative social expectations. Many researchers have pointed out that psychiatric diagnoses are plagued by problems of reliability, validity, prognostic value, and co-morbidity.


Diagnostic categories do not predict response to medication or other interventions whereas more specific formulations or symptom clusters might (Moncrieff, 2007).


Finally, disorders categorised as ‘not otherwise specified’ are huge (running at 30% of all personality disorder diagnoses for example).


Personality disorder and psychoses are particularly troublesome as they are not adequately normed on the general population, where community surveys regularly report much higher prevalence and incidence than would be expected. This problem – as well as
threatening the validity of the approach – has significant implications. If community samples show high levels of ‘prevalence’, social factors are minimised, and the continuum with normality is ignored. Then many of the people who describe normal forms of distress
like feeling bereaved after three months, or traumatised by military conflict for more than a month, will meet diagnostic criteria.


In this context, we have significant concerns over consideration of inclusion of both “at-risk mental state” (prodrome) and “attenuated psychosis syndrome”. We recognise that the first proposal has now been dropped – and we welcome this. But the concept of
“attenuated psychosis system” appears very worrying; it could be seen as an opportunity to stigmatize eccentric people, and to lower the threshold for achieving a diagnosis of psychosisDiagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses. They certainly identify troubling or troubled people, but do not meet the criteria for categorisation demanded for a field of science or medicine (with a very few exceptions such as dementia.) We are also concerned that systems such as this are based on identifying problems as located within individuals.


This misses the relational context of problems and the undeniable social causation of many such problems. For psychologists, our wellbeing and mental health stem from our frameworks of understanding of the world, frameworks which are themselves the product of the
experiences and learning through our lives.

The Society recommends a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most
strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’.
Statistical analyses of problems from community samples show that they do not map onto past or current categories (Mirowsky, 1990, Mirowsky & Ross, 2003). We would like to see the base unit of measurement as specific problems (e.g. hearing voices, feelings of
anxiety etc)? These would be more helpful too in terms of epidemiology.
While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients
often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative
benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice. Moncrieff and others have shown that diagnostic labels are less useful than a description of a person’s problems for predicting treatment response, so
again diagnoses seem positively unhelpful compared to the alternatives. There is ample evidence from psychological therapies that case formulations (whether from a single theoretical perspective or more integrative) are entirely possible to communicate to staff or
clients.


We therefore believe that alternatives to diagnostic frameworks exist, should be preferred, and should be developed with as much investment of resource and effort as has been expended on revising DSM-IV. The Society would be happy to help in such an exercise.

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Glimpses - Our Experiences with Mental Illness


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