Tuesday, November 1, 2011

Petition about DSM-5

A little over a week ago, the Society For Humanistic Psychology (Division 32 of the American Psychological Association) started a petition regarding DSM-5. It started without any big announcement and has spread largely by word of mouth, email, and a bit of blogging.

Having been put up on October 22, it already has nearly 3000 signatories, mostly mental health professionals. The open letter/petition addresses numerous problems with DSM-5. Some of these are problems that already exist in DSM-IV and are of the "easy to point out, but virtually impossible to fix in our current state of knowledge" variety. Others are particularly bad proposals for DSM-5 which they fear would be worse than the status quo, rather than better. A major part of it concerns turf battles among mental health professionals, and some history is in order here.

In 1977 (in preparation for DSM-III, published in 1980), there was a presentation by Robert Spitzer and Jean Endicott on defining "mental disorder" that defined "medical disorder" and claimed that "mental disorder" was a subset of that. Over the past several decades there had been a number of attacks on psychiatry (collectively these are often called anti-psychiatry) which argued that psychiatry is not a legitimate branch of medicine and that the concept of "mental disorder" is a metaphor at best and an outright lie at worst. Spitzer and Entidott's proposed definition was intended to challenge anti-psychiatric critiques, but it created quite a reaction among psychologists who feared that the American Psychiatric Association was doing turf-warfare, trying to get a bigger slice of the mental-health-funding pie. As a result, the "subset of medical disorders" language was not included in DSM-III and Spitzer had to write an editorial for the APA Monitor to alleviate the fears of concerned psychologists, insisting that the goal was not at all to devalue the work of psychologists or for psychiatrists to try to assert dominance in the mental health field.

Thirty years later, the DSM-5 people are doing a number of things which are setting off similar fears. Yet the fact is that physicians make up a small portion of the mental health professionals who use the DSM. Fears of turf wars remain, and one gets the suspicion that the DSM-5 folk aren't really all that sensitive to the political/guild concerns of those other guilds that use their book.

Interested readers, especially those who are mental health professionals or in related fields, are encouraged to go read the petition and sign it if you agree with it.

Spitzer, R. L. (1981, October). Nonmedical myths and the DSM-III. APA Monitor, pp. 3, 33.

Spitzer, R. L., & Endicott, J. (1978). Medical and mental disorder: Proposed definition and criteria. In R. L. Spitzer & D. F. Klein (Eds.), Critical issues in psychiatric diagnosis (pp. 15-39). New York, NY: Raven Press.