Where Are the Social Workers?: One Social Worker’s
Road to Active Opposition to the New DSM
Jack Carney, DSW
The following is the first part of a serialized, four-part version of a larger article that has been accepted for publication in a peer-reviewed journal in 2014. The larger article is a compilation of three articles written in November, 2011, and in February and May, 2012, about the DSM-5 and its anticipated adverse impact on those in emotional distress who seek help from practitioners who utilize the DSM. In the series published here, the three articles are preceded by an Introduction, which constitutes Part I. They are subsequently followed by several Afterwords written in August, 2012, and April, July and August, 2013. The Afterwords comprise Part IV; references for all four parts will be found at the conclusion each part.
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In November, 2011, the Society for Humanistic Psychology of the American Psychological Association (APA) and the American Counseling Association (ACA) sent their infamous Open Letter to the DSM-5 Task Force (Locke, 2011). When I read it shortly after it was posted on the APA/ACA website, I found myself dismayed, then outraged, but not surprised. After all, I had read Stuart Kirk’s and Herb Kutchin’s (1992) scathing critique of the DSM-III, questioning the DSM’s legitimacy, several years earlier. Their focus was on the scientific foundations of the DSM III, viz., the construct validity of the disorders or diagnoses it purported to categorize, and its inter-rater reliability or the consensual validation of those diagnoses by clinicians in the field. Their conclusions were succinct: the DSM-III evidenced neither (see also Kirk, Gomory, & Cohen, 2013).
The APA/ACA had even broader-based concerns. The authors of that lengthy letter questioned the organization of the DSM-5’s ballyhooed field trials; the ongoing medicalization of mental illness and increasing reliance by psychiatrists on psychoactive medications; and the accompanying patholigization of human behaviors ordinarily considered normative. More fundamentally, they challenged the presumption of the DSM-5 Task Force and the American Psychiatric Association to devise a taxonomy of illness with no input from professionals from other disciplines. Accordingly, they attached a petition to their letter, signed, through July, 2013, by 15,000 mental health practitioners and other stakeholders, requesting that the Task Force suspend its operations and allow a multi-disciplinary committee to review its work and recommend changes.
The Task Force, of course, proceeded with its work as per its scheduled timetable. It did listen to some of the criticisms directed its way: it removed several new child-focused diagnoses; excluded “grieving” from consideration as a Major Depressive Disorder for a two-week period subsequent to a personal loss; extended its public commentary period by two months, inviting additional input on its Personality Disorders section (Frances, 2013a). Nonetheless, the DSM-5 essentially remained as it was – more disorders affecting more people; no consideration of construct validity, which has become a non-issue; and, as reported on the Task Force’s own website, poor inter-rater reliability. Its May, 2013, publication date proceeded as planned.
My personal response after reading the Open Letter was to sign the petition, urge colleagues to sign it and write a series of five articles which were posted on two websites — www.behavioral.net and www.madinamerica.com — over a seven-month period, November, 2011 through May, 2012. Three of those blog posts, in modified form, appear in the following three sections of this paper.
The first, “1984 Revisited: The New DSM,” (Carney, 2011) is essentially my critique of the DSMs: a review of Kirk’s and Kutchin’s evaluation of the landmark DSM-III, which was echoed by Bentall (2004); of the DSMs’ continued lack of construct validity and poor inter-rater reliability; of alternatives to the DSM and its underlying biological explanation of mental illness; and a consideration of evidence-based psychosocial treatment interventions. My Orwellian conclusion: social control and unwelcome intrusions into people’s lives were about to become commonplace.
The next, “1984 & DSM-5 Revisited: Where Are the Social Workers?,” (Carney, 2012) expresses my disappointment with the social work profession for distancing itself from the DSM-5 controversy. Again, I was not surprised. I’ve been a social worker for over forty years and I know my colleagues are a cautious bunch – while individual social workers might have signed the Open Letter Petition, as I did, no social work organizations, including the NASW, did. The article upbraids social workers and our professional organizations for their non-involvement and for missing an opportunity to re-assert social work as a core stakeholder in the public mental health system; to underscore our helping mission and our commitment to the psychosocial to explain and address human distress. I conclude the second article by urging social workers to join the struggle, sign the petition and press their professional organizations to do likewise.
The third, “Boycott DSM-5? Why Not?,” (Carney, 2012b) presents that action as a rejection of the new DSM and challenges Psychiatry’s hegemonic role in determining who is ill and how best to treat them. Practical issues are also discussed – potential consequences; what to use in lieu of the DSM; the need to become familiar with the ICD-10, now scheduled for issuance in the U.S. in October, 2014; as well as with Allen Frances’s new book, an alternative to the DSM published prior to the DSM-5.
This paper concludes with a two-part Afterword, the first completed in August, 2012, the second completed in July, 2013. The former contains an update of the DSM-5, i.e., what’s in and what’s out, through August, 2012, when the DSM Task Force concluded its final public commentary period, as well as access to a powerpoint presentation entitled “Where Are the Social Workers” – I seem to be preoccupied with this question. It can be used to present to social workers, and other interested practitioners, a summary of the key issues outlined in this paper. Whether social workers will be interested in learning what’s at stake and deciding how to respond is open to conjecture. To sum up with an often abused quote and nods to Ignatius Loyola and Cornell West, “I’m not optimistic but remain a prisoner of hope.”
By the time I wrote part two of the Afterword in July, 2013, our DSM Boycott had been up and running for more than six months and I had returned to my Alinsky roots – I had originally been trained as a “grass roots” community organizer by Warren Haggstrom, who headed Alinsky’s campaign against Kodak in Rochester in the early 1960’s. Our announced Boycott goal of curtailing sales of the DSM-5 and revenue for the APA became secondary to our systems change goal of discrediting the APA and its DSM and disrupting its salutary relationships with the entities I termed the “Big 3” – Pharma, Insurance and Government. So we sought the moral high ground, began to build a mass organization via social media and pursued every opportunity to depict the APA as a corrupt and morally bankrupt organization.
Our systems change analysis and strategies are described in detail in two articles I posted at MadInAmerica.com In February and May, 2013, with more to come this Fall.
Written by Jack Carney, DSW
Content published with the Author’s permission.
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This is the second in a five part DSM V boycott series that SJS will publish over the course of a month. For previous parts and to bookmark the entire series please visit http://www.socialjusticesolutions.org/social-work/dsm/dsm-series/.
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