Within the next few weeks, after two decades without an update, the Diagnostic and Statistical Manual of Mental Disorders will released in it’s fifth version (DSM V). Here in the UK, we use a system of classifying mental illness as published by the WHO (World Health Organisation), the International Classification of Diseases. However, the DSM holds great influence not just in it’s country of inception – the USA, but globally.
As someone, whom over the years, has seen their mental health diagnoses become more Byzantine, but who is lucky enough to now have a psychiatrist that is unwilling to stick on ever more new labels and disorders. However, the DSM in it’s newly revised edition is something that concerns me, as ever more disorders are added, and the criterium for slotting into preexisting disorders and illnesses becomes less discerning.
Today, in a move that is perceived by some in the field of psychiatry as a retort to the revised DSM, the British Psychological Society will issue a controversial statement from it’s division of clinical psychology (DCP), calling for a “paradigm shift” in how mental illness is perceived and understood. The statement focuses particularly on the current, highly orthodox psychiatric model as mental illness being viewed through a biomedical prism – one that is first and foremost treated pharmaceutically. The statement is a direct and pungent challenge to these perceptions – very concrete perceptions in the minds of many psychiatrists.
The DCP said their decision to challenge these long held beliefs “reflects fundamental concerns about the development, personal impact and core assumptions of the (diagnosis) systems” which have long been part of the system of psychiatry. They went further with their concern and commented that it was unhelpful to view mental illness only through biomedical markers (or to use common parlance, chemical imbalance and/or genetic inheritance) and that:
“On the contrary, there is now overwhelming evidence that people break down as a result of a complex mix of social and psychological circumstances – bereavement and loss, poverty and discrimination, trauma and abuse.”
The DSM V edition, apart from, as mentioned earlier, lowering the thresholds for the diagnosis of preexisting illnesses, includes new “disorders”, for such “conditions” as temper-tantrums, grief, and worrying about physical health. Asperger’s syndrome has also been removed and slotted into the Autism Spectrum.
For the British Psychological Society to speak out in such a manner is a highly unusual, one might say unique step. As an individual with a complex mental health diagnosis, I await to read their statement in full with interest, but I applaud their courage, and I agree entirely with the sentiments expressed thus far. There would seem to be little doubt that in my own case, neglect, abandonment and abuse were the cause of my mental illness, yet I have been ascribed labels, which in turn lead to medicalisation. This then begs searching questions regarding the role of Big Pharma (particularly in the USA, but also in the UK and globally). I still maintain the best “medicine” I have so far received is my ongoing psychoanalysis.
It goes without saying that many psychiatrists are highly displeased with the upcoming statement from the DCP. Defensive comments have already been made by psychiatrists from the Royal College of Psychiatrists, Professor Simon Wessely remarked:
“A classification system is like a map, and just as any map is only provisional, ready to be changed as the landscape changes, so does classification.”
Whilst I appreciate he is correct – having lived for three years with a man who suffered severe Unipolar Bipolar Disorder, and became psychotic and manic concurrently on several occasions, I can recognise the need to diagnose. However he gives no nod toward the obvious, of which the DCP states. That a hybrid model of treatment is needed, and that therapy does not always mean pharmaceuticals. In fact, it should often preclude them.
Sadly, in the USA, a creaking-gate syndrome has become ubiquitous. This is happening not only in the field of psychiatry, but in pain-management too. The USA has a far lower threshold as to when children can commence treatment on extremely serious drugs such as antipsychotics, amphetamines for ADD, and antidepressants. This is because they can be diagnosed with far more serious mental health disorders at a younger age (even ADD) than in the UK. The revised DSM now makes it far easier to diagnose even more people, who may be perfectly well as ill at an extremely young age, thereby indoctrinating them into a medicalised mind-state of un-wellness and further shackling them to medication as they move into adulthood, of which both the doctor and the Big Pharmaceuticals benefit.
If one then applies this same rule to the adult population, there is a tendency to view this system with some degree of cynicism. Where distress is concerned, either mental or physical, we turn to psychiatrists and those doctors who manage pain, and we have become to expect a quick fix, without realising that not only are we cash cows for those that minister our distress, but to those ministers who then turn to the Pfizer’s and AstraZeneca’s of this world and procure for us those magic bullets.
Whilst there is no doubting that medication is a necessity in a lot of cases, in many it is not. Dealing with mental pain and physical pain (of which I’ve suffered both) has other routes of escape, but we are so immured against even considering them in the face of a tablet or magic pill, and besides, there is such a paucity of high quality therapies and management programmes for both psychiatric and pain conditions currently, that whilst statements such as the one made by the DCP are to be welcomed, there is so far to go before we can see mentally ill people living stable mentally healthier lives with a much reduced reliance on big pharma.
I currently take four medications for my mental health issues, including a large daily Quetiapine dose (antipsychotic). I dare not come off this medication, as it brings me some modicum, some amount of quality to my life, where before there was zero. I may be on this medication for years, but one day, with a change in perspective, and with the ongoing care from my already excellent mental health team, I would like to think that perhaps, just maybe, I can be medication free. This feels like a pipe dream at the moment, but medication lays very much at the heart of this issue.
There can be no doubt that however honourable many psychiatrist’s intentions may be, and I can’t say it of my own psychiatrist, they often have a blind addiction in prescribing medication immediately upon a diagnosis, when longer-term therapies, with often more positive outcomes are over looked.
