The New York Times is reporting that Dr. Thomas Insel, director of the National Institute of Mental Health (NIMH), has been critical of the DSM, and especially the DSM V which has recently been released, because it “lacks scientific validity and needs to be bolstered by a new classification system based on biology…”
The newest iteration in the series which has always had its share of controversy, for example, inexplicably classifying homosexuality as a mental illness in previous versions, exposes the basic problem facing the fields of Psychiatry, Psychology and Social Work: there is no consensus on the nature of mental illness. Where a social work school will advise the therapist to treat the client holistically, taking into account environmental, social and spiritual factors, psychiatric schools focus purely in the biological spectrum. Psychology sits somewhere in between, and social work is moving ever closer to psychology in this respect.
As these disciplines continue to classify the human experience, and are eager to serve humanity in this respect, there has been an almost pathological refusal to venture into the metaphysical realm which asks questions about the nature of the self and how it relates to the world. This is amusing since all three disciplines have their roots in a western philosophical system that is always intently focused on metaphysics.
The article mentioned that Dr. Insel believes that humanity is 10 years away from being able to use biology as the basis for mental health classification. Yet, even if the human mind can be deconstructed in such a manner, the implications are not being analyzed correctly. For example, a teenager is “cured” of an extreme anxiety disorder by the magic of modern science. This teenager feels better, and yet continues to be abused by a parent at home; the environmental cause for the initial disturbance. If treated only as a biological machine, a number of absurd consequences come about.
First, can a prediction be made for the ramifications of sending “cured” person back into that environment. The “anxious” teenager” is now replaced by one who is more emboldened, perhaps he or she takes it upon themselves to confront their parents, perhaps it turns violent? Secondly, if the analysis is to be kept on a purely biological level, does the law step in a mandate that the parents be given “treatment” as well? On the surface this sounds like a grand idea, but that is a very slippery slope. Maybe a child has problems functioning because the parents have marital problems at home. They constantly argue and are not creating a suitable environment for child to develop, is a magic cocktail in order in this case? The slippery slope is endless; it will extend itself into every single aspect of the human experience and will commit us to an Orwellian nightmare.
The basic problem: the multidimensional universe is so vast, with so many changing relationships that a true scientific approach would need to map all of existence, past, present and future, to be effective and it would need to impinge upon the basic freedoms of every single human on the planet to do so. Humanity is not 10 years from such a splendid accomplishment.
Clearly psychotropic medication is helpful in treatment, but discarding the more human approaches to treatment is to abandon the actual human that is being helped. Here is a novel idea: why don’t we approach this with a touch of humility and admit that what we do is extremely complicated. Perhaps each discipline could meet in some unexpected place where compromise, and the exchange of experience, is paramount to the delusional attempts at mastering of our universe.
The DSM V’s attempt to find some quasi scientific foothold inside the professional world is exactly its problem. If it had a disclaimer “useful guidelines” on the cover and was not treated as “Bible” of the profession, we would all be better for it. Short of mapping the entire universe, it might just be the best that we have for now, and that is good enough for me.
Written by, Matthew Cohen MSW – SJS Staff Writer
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I cannot agree more with this comment, “Clearly psychotropic medication is helpful in treatment, but discarding the more human approaches to treatment is to abandon the actual human that is being helped.” Why the push for diagnosing an individual? A label which follows one around for years if not the rest of their life. There should be more focus on the actual person and all areas of their life. Imagine a wagon wheel and each spoke represents an area of ones life: socialization, family, school or work, spirituality, health, basics of clothing, housing, food, healthcare access-the spokes can be endless…..a more holistic approach is needed no matter what field the professional is in, psychology, psychiatry, social work, mental health, health care.
No matter what area of mental health or helping profession one is in-more collaboration and more advocacy is needed re: why the DSM is accepted as being ‘the bible’ for insurance purposes and why the push to label. Too much territorial tension exists between the different helping professions and this is unfortunate as collaboration, teamwork, advocacy and social justice would and can go so much further in a positive direction if there is unification vs. division.