Because most undergraduate, graduate and postgraduate courses uncritically present the DSM as an objective scientific document, this summary focuses exclusively on the rarely acknowledged critical view. It neither provides a complete analysis of psychiatric diagnosis nor denies that the DSM, if used cautiously and appropriately, can be useful, nor does it advocate against psychiatric diagnostic.
The primary goal of this web page is to promote critical thinking of psychology and psychiatry by presenting an important, however, rarely acknowledged critique of psychiatric diagnosis.
The following summary was inspired by Dr. Paula Caplan's work and the writing cited in the Selected Bibliography at the end of this page.
The DSM has undergone a sociopolitical, economically driven evolution since its inception in 1952 when it emerged as a diagnostic tool for physicians who framed it in the medical model. Emerging from a psychoanalytic perspective, pathology was seen to reside within the individual, resulting in expression through neurotic conflict. Subsequent revisions in 1980 and 1987 evolved toward a more firmly biopsychological perspective. In a response to insurance companies' need for increasing specificity in diagnosis, we saw an increase in the number of available diagnostic labels from 297 in 1994 to 374 in 2000. The current criterion focuses on medication management of behavioral symptomology over psychotherapy. The primary elements that have survived all revisions are the intrapsychic focus and the power of political and economic agendas.
Many clinicians are unaware that the DSM is more political than scientific, that there is little agreement among professionals regarding the meaning of vaguely defined terms and that it includes only scant empirical data.
The constructors of the DSM point to the following positive uses for its system of psychiatric diagnostic codes: It can be helpful for clinicians and mental health practitioners as they construct treatment plans, especially evidence based treatment plans. It provides a consistent structure and vocabulary for professionals, which helps with communication and collaboration. It can facilitate continuity of medical care and collaboration between professionals of varying treatment modalities. It is consistent with many forms of current medical record keeping. It can facilitate unified data collection for survey, pharmacological and other research purposes. It can be instrumental for the compilation and retrieval of statistical health information. It simplifies the reporting of unified data to interested third parties, such as the World Health Organization and insurance companies.
Diagnosis of physical problems is obviously extremely helpful. In principle, psychiatric diagnosis can be helpful as well. Unfortunately, psychiatric labeling has been developed and applied in biased ways and has resulted in more harm than good.
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The major concerns regarding the DSM.
- Diagnosis of "mental illness" is more an art than a science. DSM-based research has repeatedly shown very poor reliability and, therefore, questionable validity. In a 2005 interview, Robert Spitzer, the architect of the DSM, confessed candidly: "To say that we've solved the reliability problem is just not true. . . It's been improved. But if you're in a situation with a general clinician it's certainly not very good" (Spiegel, 2005, p. 63).
- The DSM is more a political document than a scientific one. Decisions regarding inclusion or exclusion of disorders are made by majority vote rather than by indisputable scientific data.
- One telling example is the declassification of homosexuality as a mental disorder. Homosexuality was listed as a mental disorder in the DSM until 1974, when gay activists demonstrated in front of the American Psychiatric Association Convention. The APA's 1974 vote showed 5,854 members supporting and 3,810 opposing the disorder's removal from the manual. At that time, the American Psychiatric Association made headlines by announcing that it had decided homosexuality was no longer a mental illness. Voting on what constitutes mental illness is truly bizarre and, needless to say, is political and unscientific.
- External political pressure can result, apparently, in the inclusion of a diagnostic category. For example, PTSD was included in the DSM-III as a result of massive lobbying on its behalf by Vietnam vets and their supporters. Prior to that, PTSD sufferers were routinely diagnosed with character disorders.
- Due to a deadlock in gender politics, Premenstrual Dysphoric Disorder (PMDD) was placed in the Appendix.
- Unlike medical diagnoses of broken bones, lung infection or cancer, psychiatric diagnoses are not precise, accurate or objective. While different X-Ray machines, blood tests or scanning devices are likely to yield similar results for the same person, different therapists are less likely to come up with the same diagnosis for the same person. Psychiatric diagnosis is not an exact science. The differences reflect different theoretical orientations of therapists. Diagnosis, in psychotherapy, often depends on the eye of the beholder.
- The DSM is a powerful tool of social control, as its criteria is a primary tool used to judge who is normal or abnormal, sane or insane or who should remain free or be hospitalized against their will.
- Diagnostic inclusion in the DSM is influenced more significantly by the faction currently holding professional political power than by what science reveals.
- Psychoanalysts and psychiatrists, for example, influenced DSM-I predominantly and, thus, neuroticism was included.
- When medicating psychiatrists and pharmacological companies gained the upper hand, neuroticism and neurosis lost attention and anxiety became a primary focus.
- The DSM perpetuates the myth that the medical-mechanistic model can simply be applied to psychology and that by precisely identifying and naming the problem, treatment and cure will follow.
- The DSM gives the illusion that mental illness is a clearly identifiable brain disease. Unlike diseases such as coronary heart, cancer, or medical conditions, such as broken bones, there are no blood tests, X-Rays or brain imaging techniques to identify the presence of any of the DSM diagnostic categories.
- Each diagnostic criterion in the DSM is part of an ever-changing list of symptoms compiled by "experts". Some experts often represent special interests, such as pharmaceutical companies or certain brands of treatment modalities. It is not based on medical science, blood or other biological tests. The rationale seems to be: If you can describe a set of symptoms, then you can name a disease; and if you can name the disease, then you can claim it exists as a distinct "entity" with, eventually, a specific treatment tied to it.
- Designing treatments only according to symptoms (i.e., those who experience a certain constellation of symptoms of depression or anxiety should be prescribed a pharmaceutical agent) is often ineffective, at best, but can also be dangerous. Medical science does not operate in such a manner. For example, the mere manifested symptoms of pneumonia do not differentiate between bacterial, viral, mychocardial or inhalation pneumonias. Choosing a treatment based only on a mere set of universal symptoms might lead one to prescribe antibiotics for viral pneumonia, or anti-viral agents for bacterial pneumonia, leading to the erroneous conclusion that neither medication works. The same is true for mental illness, as the sheer presence of anxiety does not tell us if this anxiety is healthy as in response to real threat, normal as in response to existential concern around issues of death or meaning, psychotic as in response to voices telling the person to kill himself, or neurotic as in response to self perpetuated irrational drama. Obviously, each condition requires a different intervention, or combination of interventions, which may include medications and/or existential, behavioral, cognitive therapy, relaxation training, etc. Just as medicine goes beyond a set of symptoms by looking at lab results, x-rays, sputum, scans, etc, the field of mental health needs to find more viable forms of diagnostic criteria in relationship to treatment.
- Over the years, as psychology, psychotherapy, psychopharmacology, the DSM, and the culture at large have co-evolved, varying diagnoses have taken center stage. Prior to and during the 1940s, the pre-DSM era, most patients were characterized as hysterics. In the '50s and '60s, the most popular diagnoses tended to be neuroses and anxiety. During the 1980s, Borderline Personality Disorder became one of the most frequently diagnosed disorders, while in the '90s, childhood abuse, eating disorders, Multiple Personality Disorder and PTSD became a predominant focus. Towards the end of the 20th century and the beginning of the 21st century Attention Deficit Hyperactivity Disorder, PTSD, Bipolar Disorder, Borderline Personality Disorder and Asperger's Syndrome occupy center stage. The question then becomes, to what degree do these historical shifts in diagnostic focus reflect deep evolutionary structural changes in the nature of the psyche, and to what degree do these shifts reflect the ways in which diagnosis in general and the changes in the DSM has been determined by cultural and professional fads, driven by professional self-interest and the business economics of the psychotherapeutic and psychiatric treatment market, rather than by scientific process? While some of the changes are clearly driven by professional and economic forces, such as the increase in the number of available diagnostic labels from 297 in 1994 to 374 in 2000, that evolved in response to insurance companies' need for increased labels during that period, others clearly reflect the evolution of the culture at large. Hysteria, for example, was a phenomenon that, not surprisingly, appeared frequently in the repressed climate of Freudian times. Along the same lines, the proliferation of visual marketing media and the "thin industry" can explain the exponential increase in the number of patients diagnosed with anorexia in the last two decades.
- The DSM tends to pathologize normal behaviors. Existential anxieties, for example, are labeled "Anxiety Disorder". As a result, some kinds of normal and rather healthy anxieties are viewed and treated as mental illness. Similarly, shyness can too easily be seen and treated as "Social Phobia", lasting grief as "Complicated Grief Reaction", spirited and strong willed children as "Oppositional Disorder", fearful minorities as "Paranoid" and those who experience spiritual events as "Delusional". Consequently, many psychotherapists, regardless of their theoretical orientations, tend to follow the DSM as it is in their professional best interest.
- The DSM is primarily driven and controlled by psychiatrists, insurance companies and the psychopharmacological industry. Each group has a direct financial interest in focusing on individual pathology (rather than familial or societal), inevitably leading to medication-based solutions and shorter periods of treatment. The DSM has been referred to as the pharmaceutical companies' "bible," because without its coded diseases there would be no drug trials. Without medications psychiatrists stand to lose their place in the treatment hierarchy, and the DSM would loose its legitimacy as a necessary biological-medical tool.
- The American Psychiatric Association is the most powerful mental health enterprise in the world, and the DSM constitutes a lucrative business for their organization, garnering millions of dollars in revenue (including sales of tapes, videos, study guides, etc.). Their marketing agents enjoy a captive consumer base. The DSM is translated into multiple languages and is the key volume on mental illness that all trainees must learn from, including psychiatrists, other physicians, social workers, psychologists, psychiatric nurses, marriage and family therapists, addiction specialists and psychologists.
- The DSM tends to ignore contextual factors in the development of symptoms and disorders. Some professionals have suggested a replacement of current diagnostic labels with descriptors such as "the consequences of poverty," "the consequences of violence," "the effects of homelessness and racism" or "the damage done by interpersonal discriminatory treatment." The DSM provides an axis on which "psychosocial stressors" can be listed, but in reality, Axes I and II are the focus of diagnosis and treatment.
- The DSM focuses almost exclusively on individual pathology to the dangerous minimization of social and environmental factors such as poverty, racism, sexism, classism, heterosexism, ageism, violence, etc. This limiting focus has serious ramifications:
- Therapists, who uncritically follow the DSM medical model, are likely to place undue emphasis on individual emotional problems as causal factors rather than opening to the larger possibility that the individual is symptomatic due to familial, political or societal system dysfunctions.
- Social psychologists call such exclusion of social factors and excessive focus on individual pathology the "fundamental attribution error."
- The focus on individual pathology leads to individual based treatment, suggesting that the DSM markets the concept of individually and biologically based social discomfort.
- Drug companies fund, and reap the benefits of, a significant amount of research that is used to advocate new DSM diagnostic categories. Each of these new disorders corresponds to a drug (often new) that the company alleges can cure the symptoms of the diagnosis.
- Many labels in the DSM (e.g., neuroticism, paranoia) have not been supported by valid and reliable research to represent real entities.
- The DSM tends to pathologize several groups whose civil rights have historically been marginalized in the culture at large. The bias is clear in regard to race, social class, age, physical disability, gender and sexual orientation. Symptoms are a call for corrected balance. Rather than labeling the symptoms of a sick society, when appropriate, the client is too often diagnosed and medicated to adapt to the disease of the system.
DSM pathologizes normal behaviors and temperaments:
Labeling normal behaviors as mental disorders financially and professionally serve psychotherapists of all theoretic orientations. Following are some examples of how the DSM turns normal behaviors and temperaments into mental illness.
- Shyness or normal introversion can be diagnosed as "Social Phobia."
- The individual process of healthy grief might be diagnosed as "Complicated Grief Reaction," if it lasts a tad longer that the amount of time specified in the DSM.
- Healthy, strong willed or active children are often diagnosed as having "Oppositional Disorder."
- Children who are restless, non-compliant or not academically oriented are diagnosed with "ADHD."
- Meaningful and healthy existential angst might be diagnosed as "General Anxiety Disorder" and medicated away.
- Those with feelings of hopelessness and despair related to the burden of social injustice and poverty might be diagnosed with "Depression."
- A person who attributes spiritual meaning to a powerful insight could be diagnosed as "Delusional."
- A woman who is not sexually aroused in relationship to an emotionally disconnected partner could be diagnosed as having "Female Arousal Disorder."
- Feeling jittery and agitated from drinking too much coffee can be diagnosed as "Caffeine Related Disorder."
- People, who for reasons of being abused, stressed, uninspired or who simply choose not to engage in sexual activity, are diagnosed as having "Hypoactive Sexual Desire Disorder (HSDD)," which is described in the DSM-IVTR. This disorder is characterized by a low level or absence of sexual fantasy and desire for sexual activity. The obvious question is, "Who decides what is a low level?"
- "Gender Identity Disorder (GID)" is another culturally biased diagnosis in which any behavior that does not fall within the rigid confines of the narrowly defined and preferred sex roles prescribed by most modern western cultures is pathologized. Consideration of normal developmental phases, playfulness and individuality are often harmfully discounted in this restrictive application of diagnostic criteria.
DSM pathologizes normal behaviors and temperaments:
- White males have consistently and primarily constituted the dominant group responsible for the development of DSM nosology, deciding which behaviors are to be considered healthy and which unhealthy. Many have pointed out the following specific gender biases: attributes traditionally classified as feminine, such as the tendency to value emotional attachment and interdependence and the tendency to be cautious in expressing disagreement with others, have been codified as personality or other disorders. Conversely, traditional male gender role behaviors, such as autonomy and individualism, are seen as healthy and other behaviors, such as a tendency to view work as more important than relationships, is not codified as a disorder.
- In a clear gender biased approach, which socially stigmatizes women, natural changes in cognition and emotions resulting from normal hormonal variations are codified as Premenstrual Dysphoric Disorder (PMDD). PMDD was invented as a diagnostic category even though there is no compelling empirically identified cluster of symptoms identifiable as PMDD, there is no link between symptoms attributed to PMDD and hormonal levels, nor does adjustment of hormonal levels affect the symptoms of PMDD. As with homosexuality, the inclusion of PMDD was decided by political process when its inclusion was decided by vote of the Legislative Assembly of the APA. Interestingly, just as the patent protections were about to run out, Eli Lilly introduced a new trade name, "Sarafem," for the antidepressant Prozac and markets it for treatment of PMDD.
- There are no parallel diagnoses of PMDD for men (e.g., TDDD for "Testosterone Deficiency Dysphoric Disorder"), nor are there gender-neutral categories for dysphoria related to hormonal imbalance.
- Research has shown that clinicians take at face value what male patients say more readily than what female patients say; more readily judge a female patient as being mentally ill than they would a male with the same symptoms; more readily judge women than men to be overly emotional; more readily prescribe mood-altering medication for women than for men; and more readily assume that women are more likely to require ongoing monitoring and treatment than are men.
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Pathologizing lower socio-economic class:
- The DSM ignores the real and valid concerns of lower class members, such as poverty and lack of social power. Reactions to these essential injustices tend to be pathologized and labeled as antisocial, psychotic or paranoid.
- Research has demonstrated that even given similar symptoms, members of the dominant class are more likely to receive a diagnosis of "neurosis," while those of certain racial minorities and lower socio-economic classes are diagnosed as "psychotic." The poor almost always carry the greatest burden of sociopolitical deprivation while receiving the least of what the social system has to offer with regard to treatment. The use of the DSM generally relegates them to diagnoses suggestive of individual interventions that include individual therapy and/or medications.
- Research has shown that psychotherapists are more likely to give a DSM diagnosis (i.e., to claim that the person is suffering from a mental disorder) to clients who are insured by managed care than to those who pay for services "out-of-pocket" and are more likely to be financially affluent.
Pathologizing geriatric populations:
- The elderly are often isolated and disempowered in our culture. As a result, their understandable reactions of low self-esteem, feelings of hopelessness, helplessness, etc., are often routinely diagnosed as a mental disorder (e.g., depression or organicity). They are medicated rather than viewed as experiencing a normal reaction to social isolation and stress due to valid concerns regarding lack of available basic necessities such as food, shelter and health care.
Pathologizing ethnic minorities:
- The relationship between power and dominance relative to psychopathology has not been considered in the development of the DSM.
- The emotional impact of social injustice and racial prejudice often results in stress related illness such as the increase in hypertension among African American males, as well as powerful emotional reactions. Yet, those who express appropriate rage and realistic fears due to experiences of chronic de-valuing, harassment and injustice at the hands of police and other authority institutions, are labeled as being paranoid or suffering from impulse control disorders.
- Depression, alcoholism and suicide are rampant in the Native American culture, whose members have experienced violent occupation and colonization by the now dominant society that diagnoses them.
- Characteristics that are normal to ethnic minority cultures have been pathologically viewed through the lenses of the upper class driven DSM.
- Members of many ethnic minority groups avoid contact with mental health systems because they expect their normal cultural conduct to be pathologized.
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- The psychobiological perspective prevalent in DSM diagnosis, coupled with managed care driven pressure for short-term biological based treatment, has had a profound influence on the diagnosis and treatment of children. Results of multiple studies indicate that the use of Ritalin has tripled and the use of anti-depressants has doubled in the treatment of pre-school children during the last decade. The use of psychotropic medications, combined, has tripled in the treatment of all children less than eighteen years of age, during that same period. There is, of course, concern for the self-concept of a person who has been labeled as abnormal before he or she has even entered kindergarten, as is the case with an increasing number of children.
- Few studies have been done to show the effectiveness of anti-depressants in children, nor longitudinal studies monitoring side effects, and none of the SSRIs has been approved by the FDA for use in the treatment of childhood depression. The FDA, in fact, issued a warning in 2004 cautioning treatment professionals and parents to watch children closely for signs of increased depression and suicidality while on SSRI medications.
- As stated, diagnosis and treatment reflects the changing tides of political, economic and social trends. There is considerable controversy regarding the DSM criteria for ADHD which some refer to as a well-defined condition that lends itself to short-term biological intervention, while others express concerns that the diagnostic evolution of criteria resulted from committee consensus rather than as the result of basic scientific process. Some have called ADHD the fad diagnosis of these times, and many consider the great expansion in the population diagnosed to be a function of a cultural and economic phenomenon that goes beyond the objective reality of the diagnosis. Attention Deficit with Hyperactivity, or ADHD, diagnosis is often given without any regard to familial dysfunction and other environmental factors. Stimulant medications for the treatment of ADHD constitutes, by far, the most prescribed medication for pre-schoolers and children under eighteen years of age who are currently being treated with psychotropic medications.
Pathologizing gays & lesbians:
- Homosexuality is no longer listed by name in the DSM, but therapists can still consider it a Sexual Disorder Not Otherwise Specified. Homosexuality was listed as a mental disorder in the DSM until 1974 when the American Psychiatric Association made headlines by announcing that, as a result of legislative vote by the APA, it had decided homosexuality was no longer a mental illness. The claim that it would be deleted was functionally false because the next DSM included homosexuality with which the patient was not fully comfortable. This could easily be considered a reality based "normal" discomfort for homosexuals growing up in a homophobic culture known for hate crimes against their population. The 2000 DSM-IV still includes "Sexual Dysfunction Not Otherwise Specified" and, similarly, "Paraphilias Not Otherwise Specified," allowing ample room for therapists to justify their personal or religious prejudices and "diagnose" a homosexual as having a mental disorder.
- Autism is a neurological makeup, an instance of neurological diversity, listed in the DSM as Autism Spectrum Disorder. Autistics are sometimes described as "people with autism" despite the autism being how their minds are constructed, rather than a defect or disease. (We don't describe Mexicans as "people with Mexican.") As befits the DSM culture, there is a great deal of attention on "curing" autism. This is the same genre of unhelpful help that pathologizes women, ethnic minorities, gays, lesbians, and transgender people. There seems to be a fear in the field of medicine and psychology against differences.
- Some of you may be asking, "But autistic children act out a great deal, isn't that a problem? And how can we help?" Autistic children who are "difficult" are responding to the difficult situation of growing up in a world designed for non-autistics. For most of them, this non-autistic world is too bright, too crowded, and too noisy. (A good non-autistic empathy experiment is to imagine growing up under a bright spotlight, with the sound of fingernails on a chalkboard constantly.) As therapists, the best help you can give an autistic child or adult is to treat any problems they present to you, such as depression, anxiety, or trauma, and help develop a more autistic-friendly environment, where they are free to move and express themselves in healthy autistic ways (such as rocking, sitting, walking, listening to the same song over and over, and other instances of comfort). Like gay, lesbian, and transgender people, autistics have an uphill road living "against the grain." Our advice is Don't treat the autism. Help autistic clients be healthy autistic people.
The DSM has become a tool with which therapists can irresponsibly use their position of authority to distance themselves from their clients by labeling them as having specific mental disorders. As a result, therapists can hide behind a professional façade, avoiding the reality that many clients are simply fellow human beings who are normally suffering from anxieties, sorrows and despairs, primarily related to the multiple imbalances of our modern culture and our endangered and endangering environment. Accordingly, the DSM perpetuates the myth of professionalism and superiority so prevalent among psychotherapists at the expense of those who seek therapists' help.
Most undergraduate, graduate and postgraduate education neglects critical aspects of training in regard to the complex process of diagnosis. Few programs inform students that DSM diagnostic criteria generally lacks empirical support, that some criteria is the result of political or popularity "voting," that scientific method and evidence has been largely disregarded in its development and that issues such as gender and cultural sensitivity are grossly underrepresented. Ethical diagnosis is dependent upon a contextual understanding of the DSM as well as an individual therapist's values and biases. The current limitations in most training programs make it difficult, if not impossible, for the student or clinician to approach the DSM from a balanced perspective or to employ critical thinking in assessing the impact and utility of the tool.
In Summary: Diagnostic tools can be very helpful in assisting people in healing and becoming healthier. The DSM is more of a political document then a scientifically based text. The very frame of the DSM is distorted by a primarily intra-psychic-individual focus paired with the relative exclusion of environmental, societal, political and familial concerns. Most clinicians are inadequately trained in its use, and used without the benefit of critical thinking, it can harm more than help. More specifically, the DSM discriminates against women, minorities, the lower class, the elderly, gays and lesbians or anyone who deviates from the values of the, perhaps well-meaning but biased, dominantly upper class white male political contingency that created it. The DSM is constructed predominantly by biological psychiatrists with strong influences from pharmaceutical and managed care companies. As a result, the DSM focuses on individual pathologies that are supposedly "cured" by psychotropic drugs.
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DSM vs. The Village An Alternative Inclusive Model
The DSM is basically a tool that is designed to differentiate those who are considered healthy or normal from those who are labeled as sick or mentally ill, and there is a behavioral emphasis related to the clients' level of functioning in society. The construction of mental illness is a western cultural artifact, which can be viewed, in contrast, to the more organic and inclusive systems existing in many indigenous cultures.
Following is an example of a culture in which members who characteristically exhibit different and unique (not within the bell curve) behavior are treated in a respectful, holistic manner by the community system.
Here is an alternate view taken from Dr. Zur's experience.
"As a young scientist-limnologist, I spent some time in East Africa in the 70s. While my stated mission was to help several remote villages develop fishponds, I was more fascinated with the sense and structure of the villages. My mission to promote fish soon took second place to my interest in the psychological, sociological and spiritual dynamics of the village. I was swept up by the strong current that flowed through and around this collection of families, joining them in a circle of interdependence, acceptance and mutual support. This current embraced the strong and the weak, the good and the not so good, the healthy and the frail and the so-called normal and the different. And what a plethora of roles were to be found in this small village: the Grouch, grumbling and complaining and annoying everyone; the Clown who joked and mocked and brought laughter to every face, finding the ridiculous in any circumstance, teasing me mercilessly about my odd accent; the Witchdoctor who allowed me to observe him for days on end as he administered to the villagers and conducted the rituals; the Man-who-Talked-to-Trees; the Medium who communicated and interceded with the villagers' ancestors; and the young warriors, self-consciously leaning on their new spears, spending hours beautifying their hair and skin with red mud. Each was a treasured and colorful piece of the mosaic that made up this vital community. And to be sure, there were those who also occupied common basic roles, equivalent to our butcher, baker and candlestick maker. There were villagers who needed to be carried everywhere. There were villagers who needed to be constantly protected from harming themselves. Yet, the traditional village not only tolerated such diversity, they also, in fact, truly embraced and often celebrated the differences, offering a wide network of support for all. The village respected the roles and functions of the village shaman, the fool, the warrior and others who varied from the norm, providing them with food and shelter. Whether strong or frail, healthy or handicapped, each community member was supported physically, emotionally and spiritually. When necessary, special healing rituals focused on the mentally or physically frail."
It is likely that most clinicians entering a village, such as the one described above, with the DSM and a prescription pad under their arm might prescribe anti-depressants and cognitive therapy to the Grouch, calm the Clown down with a little mood stabilizing medication, and relieve the Witchdoctor of his ritualistic behavior with a cocktail of treatments for OCD. The Man-who-Talked-to Trees and the Medium could clearly benefit from an anti-psychotic medication and probably psychiatric hospital incarceration, while the Warriors appear to have some of the distinguishing features of Gender Identity Disorder.
Some would say they might benefit from these interventions, and then again perhaps a combination of approaches would be the ideal. That which may be considered as the most healing aspect of "village treatment" is the way in which the culture supports its different or "abnormal" members in finding their place and role in the village and identity and meaning in their experience. This is central to the definition of therapy and it is what we are most likely to lose if we allow it to be legislated away in favor of cost cutting procedures and an over emphasis on biological intervention.
Many clinicians have found artful ways in which to use the DSM as a tool of communication in service of the clients' ultimate well being. One must maintain caution, however, so that the distilled, conceptual jargon developed, in part, as a response to political, economic and social pressures does not confuse the larger contextual elements of truly helpful diagnosis. Used without benefit of critical, contextual thinking, the DSM can be unwittingly used as a weapon, perpetrating the violence of intolerance upon individuals and groups expressing diversity of many kinds. Diagnosis involves judgment. In the case of the DSM, a largely political piece of work, those holding power judge those who come to the attention of mental health professionals because they seem "different" than others. This document can be seen as a reflection of the "voters" values, biases, social status, privilege and power and as an agent of injustice rather than an empirically supported professional tool used in service of healing.
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Online Critical Resources of the DSM
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