The following is an interview held with Dr. Jack Carney, Sr. Dr. Carney is most commonly known for being the second social worker quoted by “Psychology Today” in April 2012 regarding his thoughts on the then proposed changes to the DSM-V. Dr. Carney is the National Coordinator of the Committee to Boycott the DSM-V and has been influential in opposing the changes. In addition, Dr. Carney is a blogger at Mad in America, a website dedicated to critiquing the mental health system in America.
Social Justice Solutions (SJS): Thank you for agreeing to this interview Dr. Carney. We are happy to be offering a place for social workers to further voice their opinions on the DSM-V. To start, can you tell us a bit more about your experiences as a social worker?
Dr. Carney: I got my MSW from UCLA in 1969, my DSW from CUNY in 1990, and began working in the public mental health system in NYC in 1971 at Maimonides Community Mental Health Center. There, I worked as a community organizer in a neighborhood storefront. When our Federal funding ran out in 1976, I shifted to the in-patient psych unit and worked as a line SWer in various out-patient units through 1989; at which point, I left to take the position of Director of Training of the new Intensive Case Management (ICM) program at Hunter College School of Social Work. I wrote all the training curricula for this program, much of which is still in use today, and remained connected to the program until 1998. A few years prior, in 1993, I took the job as the Director of ICM Services at FEGS in NYC, which I held until my retirement in 2010.
In addition to the above, I trained in Family Systems Therapy from 1981 through 1984 and thereafter, trained in Dialectical Behavior Therapy (DBT) in 1998 and 2000. My dissertation was on “Psychoeducational Multi-Family Therapy for Persons (Presumed) to Have Schizophrenia.” I have also participated in a multitude of training’s, conference presentations and practice-oriented research beginning in 1984 and continued to accelerate all the way through through 2010. If anyone is interested to know more about the foregoing, I’ll be happy to provide additional information via email.
SJS: Such a long history of work, amazing! And how often would you say you use or have used the DSM in your practice?
Dr. Carney: In my private practice, not at all. I use the ICD-9 (International Classification of Diseases) for reimbursement purposes. In my public sector job with FEGS, we used the DSM to ascertain the accuracy of diagnoses affixed to the Severely Mentally Ill individuals referred to us. Many of these diagnoses, particularly those ascribed to African-American men – schizophrenia – and women – schizoaffective disorder – invariably ignored their trauma and life experiences and were therefore suspect.
SJS: Okay, so you have always felt the DSM was a flawed method of diagnosis in that it ignored trauma or personal circumstances in the context of diagnosis?
Dr. Carney: DSM diagnoses always appeared flawed or inaccurate.
SJS: Okay, so, in your opinion what is the biggest flaw with the new DSM-V?
Dr. Carney: It is reductive and ignores environmental etiology. For example, Axis IV in the DSM-IV’s Multi-Axial Assessment methodology, which referenced individuals’ actual life situation and problems, has been excluded from DSM-V. Nowhere throughout DSM-V can you find any mention of a help-seeker’s life circumstance as having any importance in understanding why a person might be seeking help.
SJS: And how will these changes influence the client population you work with specifically?
Dr. Carney: The changes, and the DSM in general, unnecessarily denigrate and demoralize clients. Remember, the earlier versions of the DSM – III, IIIR, IV and IV TR – were not that different from the DSM-V. Yes, they had fewer bizarre diagnoses, but they were still rooted in the biomedical model. Further, they had the same flawed construct validity and inter- rater reliability. The DSM-V just continued the DSM’s downward trend in both areas.
SJS: What about on a broader level? How will these changes influence the broader context of the mental health field and the social work profession?
Dr. Carney: The DSM and the American Psychiatric Association have had unceasing deleterious impact on the mental health system and the social work profession for the past 30 years, or since the publication of the DSM-III and the establishment of the bio-medical model as hegemonic. The epistemology of people’s distress, to be found in their lives’ narrative, has been sacrificed to a factitious science – hence the reductionistic effect of the DSM and the bio-medical model.
Social work as a profession has similarly been obliged to sacrifice what it does best, help persons where they are or in their environments. Instead, it has assumed the task of enforcing psychiatry’s default treatment plan (psychoactive medications) for those who have come seeking help. In the words of John Read, a NZ psychologist, SW, along with the other helping professionals, has been “colonized” by psychiatry and its bio-medical model.
SJS: Can you think of a more beneficial approach to diagnosis than the DSM?
Dr. Carney: No diagnosis at all. Rather, a careful recording of help-seekers’ descriptions of their problems; of what Richard Bentall, a UK psychologist, terms their “complaints.” Our next step in our Boycott of the DSM-V campaign will be a “no-diagnosis” initiative sometime this Fall.
SJS: I feel that some clinical social workers might find it hard to comprehend seeing clients without diagnosing, particularly because it is a valuable tool to contextualize a patients concerns, needs, and potential treatment plans. That being said, do you believe there are some instances and/or reasons why diagnosis and therefore the DSM might be beneficial to practice as social workers?
Dr. Carney: No. None. Social workers will have to struggle to think outside of the DSM box. My belief is that they will eventually do so by recalling Social Work’s basic “person-in-environment” ethos and discarding the bio-medical model.
SJS: Okay. So, what do you believe led the mental health professions to make such changes as those being suggested in the DMS-V?
Dr. Carney: There is no one “mental health profession;’ rather there is a disparate public mental health system staffed by members of several professional disciplines – nursing, SW, psychology, counselors – all subordinate to hegemonic psychiatry. This process of subordination or colonization has been taking place over the past thirty years, with only small groups of psychologists raising any public protest.
SJS: Why do you think Social Workers have been so silent regarding these and other changes, including policy; standard and/or diagnostic changes which influence how we work with our clients?
Dr. Carney: Social Workers have no foresighted leadership and an existing leadership that, as in all other so-called “liberal” professions in the U.S., has been “following the money,” i.e., doing what it believes it needs to do to survive; or, more accurately, seeking the approval of what I term the Big 3 – Pharma, Insurance & the Feds – and Psychiatry. The price has been enormous, the sacrifice being that of SW’s unique identity as a progressive helping force, coupled with the demoralization of line SWers and the financial deterioration of SW’s national organization. The only, and ever the best, option is and has been rejection of psychiatry’s factitious science and a reliance on SW’s environmentally-rooted and person-centered practice. In short, back to the basics.
SJS: To sum things up, where do you believe the field of mental health will go from here, and what role can social workers play in moving the field forward?
Dr. Carney: The current mental health system is a doomed endeavor. Given its enthrallment to the Big 3, it cannot be of service to those who come seeking help. Rather, individuals are captured and marginalized by the Public Mental Health system, much as they have been for the last 160 years, since the founding of the States’ mental institutions. It cannot shake its historical roots and mission, and reflexively reverts to a system of social control rather than one of help and facilitation. For example, all of New York States existing mental hospitals must be closed and either demolished or converted to other uses; the same holds true in all the other 49 states. Further, all involuntary in-patient and out-patient laws must be repealed. It should be noted that the UN Convention on Human Rights terms all involuntary treatment as torture.
Social workers need to develop strategies that will enable them to play dual roles — an obstructive force and a liberating force in the current system; they also need to begin developing a picture of how an alternative system might function – This should include the option of NO SYSTEM AT ALL.
SJS: So like you said, it’s all about back to basics! Again, thank you so much for your time, and for your many years of work in the profession!
If you are interested in finding out more about Dr Carney’s work you can visit the following links:
Written By Georgianna Dolan-Reilly, LMSW
SJS Staff Writer
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