DSM-5 Boycott Enters 2nd Phase: A Primer for the NO-DSM Diagnosis Campaign

I – DSM-5 Boycott: Yes, the boycott of the DSM-5 continues. I can’t tell you how many fewer DSMs have so far been purchased as a result of the boycott; and conversations I have had with professionals in New York’s public mental health system lead me to believe that the great majority continue to accept the validity of the biomedical model and the centrality of psychoactive medications in the treatment of persons caught up in the public system. Perhaps that’s the most important argument in support of the boycott’s continuation – we have so many more folks to reach.

To date, 2136 persons have endorsed our boycott statement; little more than 4,000 individuals supported the petition of the International DSM-5 Response Committee, composed in the main by members of the Clinical Psychology Division of the British Psychological Society and Division 32 of the American Psychological Association. Approximately 2000 Spanish and French professionals, psychoanalysts for the most part, also signed petitions opposing the sale of the DSM-5 — in sum, little more than 8000 persons in the U.S. and Western Europe, a comparatively miniscule number when one considers the millions of DSMs the American Psychiatric Association anticipated selling.

However, from our perspective, we succeeded in identifying and establishing communication among the more ardent DSM skeptics in the U.S. and Europe. Largely via social media, this cohort succeeded in reaching out to thousands more and was at the core of the barrage of criticism loosed on the new DSM. I believe that, collectively, we had a large hand in discrediting the DSM and in leading the NIMH, less than a month before its mid-May publication, to publicly reject the DSM as its primary research classification tool. In short, we accomplished two of our principal objectives — exposing the DSM’s construct or scientific validity as a myth and disrupting the APA’s relationship with one of its principal supporters, the National Institute of Mental Health. Which brings us to the next phase of our collective endeavor.

II – NO-DSM Diagnosis Campaign: In the U.S., the Boycott Committee, whose efforts I have coordinated since we launched it last February, will shift our focus to the issue of diagnosis. Specifically, we will initiate with the publication of this article a NO-DSM DIAGNOSIS campaign and attempt to identify those practitioners who do not or are willing not to assign DSM diagnoses to the persons who seek their help. Our immediate objective is to develop a list of such practitioners and make that information available via the Resources/Services Directory found on MIA’s website and coordinated by Laura Delano. We also wish to expand that core group of practitioners opposed to the DSM’s diagnostic classification system and its reliance on the biomedical model, and lay the groundwork for the third stage of our anti-DSM/anti-APA initiative. This will be launched next year and will challenge the new ICD-10 and its congruence with already discredited DSM classifications; which, in turn, will involve confronting the World Health Organization (WHO), charged with the release of the ICD worldwide, and the U.S. Department of Health and Human Services (DHHS) which is responsible for the U.S. version of the ICD. Interestingly, ICD 10 is scheduled to be issued in the U.S. by DHHS in October of next year, 20 years after it was issued worldwide; ICD 11 is currently scheduled to be issued by the WHO the following year.

Our British, European and American colleagues of the International DSM-5 Response Committee will also continue on. They recently merged with the Global Summit on Diagnostic Alternatives (GSDA) Committee, which members of the Response Committee had helped organize. Their plan calls for the two committees to constitute a Collaborative Committee or Task Force on the Future of Mental Health Diagnosis, and to focus on developing alternatives to the nosology or classification system of the DSM-5. Additional information about the nascent committee can be found at www.dxsummit.org. Readers of MIA will recognize Lucy Johnstone, a member of the Task Force, and recall her several articles about what she has termed “psychological formulation,” which entails the rejection of all categorical diagnoses and their replacement by a compilation of the nodal or key historical events of a patient’s life and the identification with her/him of key problems to be addressed. I’ve become a partisan of Lucy’s approach – very reminiscent of classical social work’s psychosocial assessment – and have promoted what she is advocating in two posts of my own on MIA.

We intend to collaborate with the Diagnosis Task Force; in fact, several members of our Boycott Committee have membership on the Task Force. We plan to disseminate to the receptive practitioners we identify the diagnosis alternatives, actually the assessment strategies, developed by the Task Force. This will involve sponsoring training seminars in the general vicinity of areas where our Committee members live and work – those who attend will be expected to train others and so expand our learning and activist networks. More on this below. In sum, this makes for a somewhat indeterminate division of labor between the two groups: the Task Force, comprised in the main of academics and researchers, will work to develop new and collaborative treatment approaches; our Committee, predominated by activists, will seek to recruit those who can make use of the new technologies and who will join us in challenging the APA’s relationships with the WHO and the HHS.

To be sure, the implementation of our NO-DSM DIAGNOSIS initiative will be difficult and complex. The remainder of this article is essentially a primer on the provision of psychotherapy without diagnosis and is addressed to those persons I consider its principal constituents — professional practitioners, those who use their services and the latter’s family members and friends

III – Practitioners in Private Practice: To begin with the practitioners, and I’ll address you directly, it’s important to recognize that you don’t comprise a monolithic group. You differ as to training, skill, experience, gender, ethnicity; yet it’s your practice venue – private practice vs. the public mental health system – that will govern how you change your practice to exclude categorical diagnoses; that will determine the difficulties you will encounter and the choices you will have to make. Specifically, to eschew the use of categorical diagnoses is to repudiate the hegemonic status of the biomedical model as well as the misuse and abuse of psychoactive medications. From what psychotherapists in private practice tell me – as well as from my own personal experience – it’s easier to do all these things – not diagnose; challenge the biomedical model; question the prescription of medications – in your own private office. Not easy just easier than it would be in a public clinic.

If a user of your services plans to submit an insurance claim form or if you do, all insurance companies or governmental third party payers – Medicare, Medicaid – require an ICD diagnosis code. So do criminal and civil courts, to name just two other institutional stakeholders. Ultimately, the assignment of an ICD diagnosis, in most instances, will be unavoidable, but it can be compartment-alized as an administrative or financial necessity and kept separate and apart from the actual psychotherapy in which you engage your patient.  (If it’s at all reassuring, the third phase of our campaign, to be initiated early next year, calls for us to challenge the use by the WHO and the US DHHS in their respective versions of the ICD of categorical diagnoses identical to those in the DSM that have already been shown to have no scientific validity. Those two entities have yet to feel any political heat about the validity of their own diagnostic nosology and it’s time that they do.) Further, you and the user of your services should review the range of diagnoses that can be submitted and select one that you both consider apt yet least harmful to your patient’s sense of self.

The more difficult task will be to keep your work together totally free of categorical diagnosing. The focus should be on helping your clients construct their own narrative or story as to how they got in the fix they’re in, and how and why they came to you for help. The data you compile can then be used to formulate hypotheses as to cause, consequence and remedy. This is at the core of psychological or collaborative (my term) formulation. As described by Johnstone and others, particular attention needs to be paid to the environ-mental factors – poverty, racism, trauma & abuse – that are known to correlate directly with individuals’ manifest distress, i.e., behaviors ordinarily considered by practitioners as pathological and indicative of mental illness. To borrow a phrase from, of all people, Harry Reid – he was referring to the obfuscatory notion advanced by the NRA and cowardly politicians that improved mental health services in lieu of tighter gun control measures will prevent mass murders — DSM’s categorical diagnoses function as a “fig leaf” to conceal the real-life determinants of individuals’ problems and their consequent  problem behavior. DSM-diagnosis-driven practitioners will tend to pursue information to confirm diagnoses rather than develop explanatory hypotheses that will promote clients’ understanding of the course their lives are taking. “Formulation” sans diagnosis can serve to obviate that, provided that you, the practitioners, are sufficiently aware of where the use of categorical diagnoses will lead you and of the alternative that “formulation” offers. A summary of formulation’s key aspects will be provided below.

IV – Practitioners in the Public Mental Health System: Those of you who are practitioners working in the public sector face what seem to be an insurmountable barriers should you attempt to work with your clients DSM-diagnosis-free. First, from what I know of mental health clinics in NY State – and I assume the same applies to all tax-funded treatment facilities in all the states — clients are eligible for admission to a clinic only if they have a “diagnosable mental illness.” The psychiatrists who screen for admission conduct a “psychiatric evaluation,” whose primary purpose is to determine that. The events in the client’s life and environment that prompted her/his visit to the clinic are noted, but they are considered of secondary importance and of only minimal relevance in establishing a DSM diagnosis. Accordingly, when the client gets to you, her/his assigned psychotherapist, she/he comes already labeled. What’s left for you to do?

Be subversive. Focus on the environmental and fundamental factors that brought your client to you. Folks who come to public clinics are, in the main, poor, abused and subjected to racism and maligned for their presume mental illnesses. Much of the abuse they’ve been subjected to has come at the hands of psychiatrists and other mental health professionals who have hospitalized and medicated them against their wills and better judgment and have invalidated them as persons. To be helpful to your client, your job will be to do what I outlined above – gather information, develop hypotheses conjointly with her/him, and assist the client to make the connections between his immediate and larger societal environments and how she/he got caught up in the public mental health system. Your principal objective is to help your client find meaning in her/his life to date and life still to be lived. More immediately, and perhaps your first opportunity to do your bit to undermine the biomedical treatment regimen your client will be prescribed, you will find yourself obliged to address with the treating psychiatrist the issue of the medications – yes, sure to be a cocktail – she/he is prescribing, their adverse consequences and psychosocial treatment alternatives.

Since you will find little support and much active opposition from your superiors, the treating psychiatrist and many of your co-workers, you will need to acquire, if you have yet to do so, a keen awareness – what Johnstone and colleagues refer to as “reflectiveness” – of the agency and systems barriers you will encounter, the barriers the client will bring to the process, and your baggage, in the form of the explanatory theories of human behavior that you make use of. Why? Because all of the foregoing can and will interfere with the collaborative formulation you will be attempting with the client. To do this on your own in a probably less than receptive work environment will prove impossible, largely because the process in which you are involving yourself and your client can be so easily undone by others. If you’re committed to work DSM-diagnosis-free, you will have to find allies among your co-workers, form a collaborative support group, one that can function in the open or sub rosa, and undertake what Johnstone, et al, term a “team formulation.” The latter will be distinct from the therapy in which you and the client are collaborating, and will concern itself with developing hypotheses to address the agency and systems barriers you encounter. It can also be the venue to review the collaborative formulation you and the client have pieced together. Nonetheless, it will remain outside “formulation as process,” i.e., as not integral to the psychotherapy, and will instead be more correctly regarded as “formulation as event,” which, in practice, rarely involves the client.

Ultimately, “team formulation as event” seems better suited to address the work-related barriers that can undo what you’re attempting and will prove essential to promote and protect your work with your client. To re-frame what I had written earlier, the most ubiquitous barrier and the one directly related to categorical diagnosis is the prescription of psychoactive medications. You must remember that the great majority of folks who seek help in public clinics are those with long-term tenure in the public system and who have been prescribed psychoactive meds for many years. For most psychiatrists, as well as other practitioners and the clients themselves, this longevity proves the case that they are mentally ill and require meds to function at their best. In any event, no client, no matter her/his length of time on meds, can suddenly stop taking them without risking often severe withdrawal after-effects (usually considered by most professionals as symptoms of relapse). The dosage being prescribed must be titrated down, i.e., reduced over time, to mitigate these consequences and promote the client’s self-belief that these meds are not necessarily essential to her/his well-being. (Will Hall’s Harm Reduction Guide offers a practical, step-by-step approach to attain this end.) In my estimation, this is the essential task to be addressed if your work with your client is to be free of the distortion of a categorical diagnosis. Its attainment without the support of others will be difficult if not impossible to achieve.

V.- Users of Service: Let me begin with this key clarification – your participation in the process of formulation is a choice for you to make. Many of you will prefer to retain the diagnosis that’s been assigned to you since it provides an explanation for the distress you’ve been experiencing. Ultimately, your decision to participate or not will depend on your answers to the following questions: can formulation as described above, as a collaborative process between you and the practitioner working with you, help you? Will formulation as an alternative to a categorical diagnosis lend meaning to your life?

Frankly, that’s for all of us to ascertain. We’re embarking on an exploration to find out. One things that’s certain, whether you’re involved in a psychotherapy grounded in formulation or not, the principal task for a user of service is to find a practitioner who will actually listen to what you have to say. Unfortunately, this appears to be an increasingly rare occurrence in encounters between practitioners and users of service, particularly if the client’s story contains content ordinarily considered “psychotic.” After all, if the distress you’re manifesting is the consequence of an underlying biological vulnerability and is indicative of a mental illness, what’s there to listen to?

Remember the “Truman Show” (1998) with Jim Carrey, where unbeknownst to the Carrey character, his life is actually a TV sitcom with him in the starring role. In the “Unreality Star,” an article in the September 16 issue of The New Yorker, Andrew Marantz writes about Nick Lotz, a young man suffering from what’s become known as the Truman Syndrome, a persecutory fantasy gaining traction among young people. (With the NSA listening in and the omnipresence of cameras of all shapes and sizes in daily life, makes sense to me.) The unfortunate Mr. Lotz thought that he, too, was being filmed and his actions governed by off-stage producers. So long as he adhered to their directions, he would remain eligible for a $100 million grand prize. Psychiatrists whom he saw at the behest of his parents labeled him as schizophrenic and invariably dismissed his story as just another paranoid delusion. Not surprisingly, Mr. Lotz became beleaguered with intrusive thoughts, his isolation increased and his parents despaired for his safety and well-being. It wasn’t until he began living in Los Angeles with his father and got to meet Dr. Steven Marder that his life began to turn around: Dr. Marder actually listened to his story. As related by a resident psychiatrist at Marder’s clinic, “[the clinic] was the first place where he felt listened to, and where people took his feelings and thoughts seriously.”

If your therapist won’t listen to you and your stories, no matter how crazy and bizarre they might sound, a collaborative effort becomes moot and the meaning at the heart of your stories will never be uncovered. So that’s task one for you to carry out – get your therapist to listen to you or find another. Task two is to tell your story. And if you think your story isn’t worth telling or you have no story-telling skills, you will need a therapist who will show an unrelenting interest in what you have to say and will teach you how to tell stories: she/he will model story-telling; suggest stories for you to read; have you write down your stories and read them to her/him and other persons you trust and can confide in. Essential-ly, a coherent narrative of self will mirror an equally coherent sense of self. In addition, you must be sure to insinuate yourself into the “formulation” of the source of and remedies for your emotional distress, both the individual formulation which is integral to your psychotherapy and the formulation by a team,   whether in a public clinic or a private practice venue. The team formulation might be a primary source of support for the professional you’re working with and it might be a forum where he can safely voice his frustrations at the barriers each of you are experiencing, but you must be present whenever the topic of discussion is your individual formulation and the agency and systems barriers obstructing it. Professionals are usually discomfited at the presence of a client, particularly one accorded and comfortable with equal participatory status, but they’ll eventually learn how validating your direct involvement will be for all of you.

Finally, just as your therapist will need support in developing with you a useful formulation, so too will you. If you’re fortunate, family and friends can be a source of support. I happen to view as usually more effective organizations comprised of peer survivors and other users of service because of their visceral understanding of what you will be undergoing as you seek to put your life in order.

Recently, I’ve come to view the Hearing Voices network and its member groups as particularly helpful since their purpose for being is to help individuals assign meaning to the voices they have heard and might still be hearing. Hearing Voices groups also develop with their members “constructs,” their version of formulation. Most importantly, they are representative of a phenomenon so widespread as to be almost universal – approximately 70% of all persons in the U.S. labeled with schizophrenia have heard voices; as compared with as many as 20% of all men and 30% of all women in the general population, the vast majority of whom have never been considered mentally ill.  Join!

VI. – Brief Summary of Formulation: As we near the conclusion of this paper, it might be helpful to provide a synopsis of the key elements of collaborative formulation. Specifically …

Psychological or collaborative formulation can be construed and made use of as an event, distinct and apart from any psychotherapy involved. This is best illustrated by a team formulation, where colleagues meet to discuss and devise a plan or plans to more adequately understand the problems presented by an individual service user.  Formulation-as-event can also be constructed by an individual practitioner, apart from her/his client, to develop more apt hypotheses re. the emotional distress experienced by the client. This latter, however, would contradict what I see as formulation, viz., a collaborative process between practitioner and user of service integral to the therapy both are engaged in.

The objective of formulation-as-process is to restore personal meaning to the client’s life experiences via the assemblage of explanatory hypotheses and a coherent life narrative. It is important to note that formulation-as collaborative process does not require that the practitioner and client agree on the meaning or details of this narrative – a reflective practitioner will acknowledge that the narrative developed is the client’s own. Open disagreement, so long as mutually respected, will allow for re-formulation by one or both further on down the road.

Finally, formulation can be used as complementary to or as an alternative to categorical diagnosis. The former, however, increasingly used by British psychiatrists, relegates environmental factors as secondary to biological in explaining an individual’s emotional distress. On the contrary, formulation as a stand-alone explanation allows the client to understand the distress in a wider societal context and as more than an individual phenomenon and an indication of illness. It also frees the client to extract from her/his experiences the personal meaning essential to her/his sense of self. To quote from the “Good Practices Guidelines” devised by the Division of Clinical Psychology for the training of its members:

“…Rather, the experiences that may have led to psychiatric diagnosis (low mood, unusual beliefs, etc.) are themselves [now] formulated … the addition of a psychiatric diagnosis becomes redundant. In Bentall’s words (2003, p. 141): ‘Once these complaints have been explained, there is no ghostly disease remaining that also requires an explanation. Complaints are all there is’.”

Some caveats:

  1. “Psycholgical (or collaborative) formulation” has been practiced for more than one hundred year, beginning with Freud, who termed it “case formulation.” Over time, its usage has ebbed and flowed – some members of our Committee trained in the 1960’s and ‘70’s were trained in psychological formulation. Of late, given the disillusion with the biomedical and illness models and the resurgence of interest in environmental factors as explanatory, formulation has experienced a renewed interest among professional practitioners and researchers, regardless of their practice orientation and training.
  2. “Psychological formulation” does not require a specific theoretical practice perspective. Resumption of its use is being led by clinical psychologists with a wide variety of orientations  — cognitive behavioral; psychodynamic; systemic; societal/social justice, etc. Interestingly, some are beginning to look to develop an integrative theoretical model that will be comprised of those several perspectives. (Johnstone and Dallos , with an assist from Dillon, devote two chapters of their recently published text, Formulation in Psychology and Psychotherapy [2013]  to this issue.) Johnstone and colleagues have also initiated outreach to other professionals, an effort we are joining.
  3. “Team formulation” is a relatively modern phenomenon; and while it seems ripe with possibility, little research has been completed to demonstrate its utility. Whoever attempts team formulation will be breaking new ground and therefore needs to document its process and outcomes. Researchers’ ambition is to see formulation, in all its forms, validated as a “best practice.”
  4. To date, “psychological” and “team” formulation have rarely been collaborative ventures, with users of service and their formulations either not solicited or accorded secondary status. Since this appears to me a replication of the status quo, i.e., business as usual, neither form of formulation seems likely to serve as an alternative to categorical diagnosis unless the formulation process becomes truly collaborative. This, of course, requires the explicit acknowledgement by both practitioner and client that the narrative or story being assembled is that of the client.

The Hearing Voices networks, particularly in Britain, appear to have become adept at formulation, which HV members term as “constructs.” Significantly, these constructs, often assembled in HV groups, are developed without the help or involvement of professionals. Instructive, no?

VII. – Training: So how will you become familiar with  collaborative formulation’s  “key elements” and learn how to put it into practice as an alternative to categorical diagnosis? Just like the British clinical psychologists, via formulation-related training.

I’m not talking about a didactic exercise, since I anticipate that most professionals interested in learning about formulation will be experienced practitioners and will have been trained in one or more of the commonly practiced psychotherapies. They will not be novices but rather skilled or on their way to getting there. Their principal task will be to create for themselves a self-awareness – a “reflectiveness,” as Johnstone terms it – of when they slip into categorical diagnosing and begin to think of their clients as mentally ill; when they stop soliciting from them their stories and begin imposing their own formulations; when they forego the conjoint development of explanatory hypotheses. This can probably best be accomplished via group discussion, utilizing a format akin to a team formulation – in this instance, the team or training group will address a series of issues or barriers and develop hypotheses aimed at their resolution that will promote self-awareness. Illustrations will be provided in the sample training program outlined below.

Yes, there will be a formal curriculum, at least in outline if not content, with discussion topics initially suggested by the group facilitators. It is our expectation that the “facilitators” – not “instructors” or “leaders”, since none of us will know enough about formulation to assume those roles – will be Boycott Committee members. Their job will be to get the groups going, promote their coherence, and secure a commitment for their continuance. It is our hope that new Committee members can be recruited from the groups and that, over time, the groups will comprise a network of individuals committed to “no-diagnosis” and our objective of developing alternatives to categorical diagnoses.

Users of service should also be trained. My preference is for service users to join the training groups and learn what the professionals will learn. Remember, we’re after a true collaboration between practitioners and their clients. During the last five years or so administering my case management programs, I always trained my staff and their clients conjointly. My staff, who had been trained to work collaboratively from the git-go, got to see their clients in a new light and learned more from the experience than they anticipated. After all, the clients who participated in our training sessions entered them as trainees, equal in status, at least in the training setting, to their case managers. Both cohorts were there to learn new things and acquire new skills. The same, I believe, will prove true in the training groups I am proposing. Both service users and practitioners will have to learn how formulation works – the former, by virtue of their participation, will trust that collaboration will be more than a word. For their part, the professionals will see firsthand what works and what doesn’t with the clients in attendance and will be better positioned to train their other clients. Each professional’s price of admission to the training session will be an invitation to one client to accompany her/him.

Since we will be learning as we go, we will devise a simple, before-and-after evaluation to determine what participants actually learn and which aspects of the training program facilitate their learning. I envision the initial round of training as comprising six two-hour sessions conducted in the home city of the group facilitator. (I plan on leading the first round of training sessions in my home in Brooklyn.) At its conclusion, participants can decide whether they want to add training sessions and have the group continue or not. Further, those participants who feel they have attained a basic understanding of formulation and feel comfortable assuming the role of facilitators will be able to do so, either in the groups in which they are members, freeing the original facilitator to move on and organize a new group, or moving on and starting new groups themselves. The training groups themselves will be comprised of 6-12 members and will include professionals and service users involved in private practice or the public sector. Finally, a small fee will be charged, not to compensate the facilitator but to pay for group-related expenses – refreshments, supplies and, where necessary, rent for the space being used. Any and all fees will be negotiated by group members immediately before or at the start of the training sessions. If we are fortunate enough to grow and attract a sizable number of training participants, training via teleconferencing should become a viable option.

VIII. – Suggested Initial Training Program: Since we’ll be on a learning curve, the training program we start with can be expected to evolve over time. The program outlined below is based on the best practices for psychological formulation developed for British clinical psychologists who are members of the Division of Clinical Psychology of the British Psychological Society. It was issued and began to be utilized in December, 2011, and is entitled “Good Practice Guidelines on the Use of Psychological Formulation.”

Training Outline for Practitioners & Service Users:

1.     What is formulation?

a.     As process
b.     As event
c.      As an individual collaboration
d.     As a collaborative team process
e.     Role of professional
f.       Role of user of service

2.     Formulation practice from a variety of professional and theoretical perspectives:

a.     Cognitive Behavioral
b.     Psychodynamic
c.      Family systems
d.     Societal/Social Justice/Social Change
e.     Narrative
f.       Psychology v. Social Work v. Nursing v. Psychiatry v. Peer Specialist v. other – differences and similarities

3.     Formulation as an alternative to categorical diagnoses:

a.     Lack of validity of the DSMs
b.     Why the ICD?
c.      Repudiation of the biomedical model
d.     Environmental Factors and their correlation to emotional distress
e.     Extracting personal meaning from life experiences

4.     Barriers to be addressed:

a.     In your private practice
b.     In your agency
c.      In the mental health system
d.     In you
e.     In your clients
5.     Attaining self-awareness:

a.     As practitioner
b.     As user of service

6.     Conclusions:

a.     Issues still to be addressed
b.     Continuation or termination of group

IX. – What to do?   If the foregoing has struck a sympathetic chord in you, you can proceed to undertake the following to promote the use of collaborative formulation as an alternative to categorical diagnoses.

First, sign our petition at [ipetition website] and endorse our campaign to stop the practice of labeling individuals suffering from emotional distress with categorical diagnoses and reducing  their life experiences to classifications that denote mental illness.

Please remember that we’re attempting to identify those practitioners in private or public sector practice who do not affix DSM diagnoses to their clients; who utilize ICD diagnoses solely for insurance payment or administrative purposes; and who involve their clients in a process of selecting ICD diagnoses that their clients do not consider demeaning. We hope to compile a listing of such individuals and make the list accessible to service users in the reference and resource section of the Mad In America website (www.madinamerica.com). Our thanks to Laura Delano of the MIA staff who oversees resource information posted on the website for her help and cooperation. Accordingly, please be sure to identify your professional/practice affiliation and the City and State where you practice. Service users and family members who sign the petition should do the same so we can determine where “no-diagnosis” sentiment is strongest as well as weakest across the country.

Second, if you are interested in participating in the “formulation” training; or in joining the National Coordinating Committee to Boycott the DSM-5, which is promoting both the DSM-5 Boycott and the No-Diagnosis campaign; or in having you organization co-sponsor either or both initiatives, please contact us on Facebook at www.facebook.com/NoDsmDxCampaign.

If you don’t have a Facebook account, feel free to e-mail me at jacarneysr@aol.com. We will promptly respond to your expressions of interest as well as to any questions you might have.

Third, help us get the word out: circulate this article; circulate the NO-Diagnosis Campaign and DSM-5 Boycott Petitions — http://www.ipetitions.com/petition/no-dsm-5-diagnosis and www.ipetitions.com/petition/boycott5, respectively —  to colleagues and friends.

Additional information about both is to be found at each initiative’s respective website,

http://nodsm5diagnosis.com/and www.boycott5committee.com. All these sites are linked and are accessible to one another.

Fourth, don’t mourn or blanche or hesitate at tackling these issues – learn more about them by accessing and reading the references listed below, particularly those written Lucy Johnstone and colleagues, ORGANIZE and join us.


X – References:

Chaudhury, S., “Hallucinations: Clinical Aspects and Management,” Journal of Industrial Psychology, January-June, 2010, Vol. 19, No. 1, pp. 5-12, http:www.ncbi.nim.nih.gov/pmc/articles/PMC3105559/

Dillon, Jacqui, “The Hearing Voices Movement: Beyond Critiquing the Status Quo,” January 10, 2013, http://www.madinamerica.com/2013/01/the-hearing-voices-movement-beyond-critiquing-the-status-quo/

Division of Clinical Psychology, The British Psychological Society, “Good Practice Guidelines on the Use of Psychological Formulation,” December, 2011

Johnstone, L., Dallos, R., eds., Formulation in Psychology and Psychotherapy: Making Sense of People’s Problems, 2nd ed., Routledge, London and New York, 2013

Marantz, A., “Annals of Psychology: Unreality Star,” The New Yorker, September, 16, 2013

Tien, A.Y., “Distributions of Hallucinations in the Population,” Social Psychiatry and Psychiatric Epidemiology, 1991, Vol. 26, No. 6, pp. 287-292, http://link.springer.com/article.10.1007/BF00789221#page-1

Written by Jack Carney, DSW
SJS Contributor

This post was originally published at http://nodsm5diagnosis.com/2013/11/27/dsm-5-boycott-enters-2nd-phase-a-primer-for-the-no-dsm-diagnosis-campaign/, and was syndicated with the author’s permission.


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  1. charles lange December 5, 2013
  2. Karen Franklin, PhD December 8, 2013

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