Sunday, 19 June 2011

The BPS on the APA's DSM

So the British Psychological Society have published a response to the American Psychiatric Association's development of the DSM-5, the forthcoming edition of what is frequently (and perhaps worryingly) referred to as the "bible" of mental illness. The response is public and worth, at the very least, a quick read. Some points I found noteworthy;
"The Society recommends a revision of the way mental distress is thought about, starting with recognition of the overwhelming evidence that it is on a spectrum with 'normal' experience, and that psychosocial factors such as poverty, unemployment and trauma are the most strongly-evidenced causal factors. Rather than applying preordained diagnostic categories to clinical populations, we believe that any classification system should begin from the bottom up – starting with specific experiences, problems or ‘symptoms’ or ‘complaints’."

"While some people find a name or a diagnostic label helpful, our contention is that this helpfulness results from a knowledge that their problems are recognised (in both senses of the word) understood, validated, explained (and explicable) and have some relief. Clients often, unfortunately, find that diagnosis offers only a spurious promise of such benefits. Since – for example – two people with a diagnosis of ‘schizophrenia’ or ‘personality disorder’ may possess no two symptoms in common, it is difficult to see what communicative benefit is served by using these diagnoses. We believe that a description of a person’s real problems would suffice."
On gender dysphoria;
"Of particular concern are the subjective and socially normative aspects of sexual
behaviour. We are very concerned at the inclusion of children and adolescents in
this area. There is controversy in this particular area – the concept of a ‘diagnosis’ of
a ‘psychiatric disorder’ disputed.

Labelling people who need help as ‘ill’ may make supportive and therapeutic
responses more difficult."
On neurocognitive disorders;
"We have no specific comments on these disorders, other than to say that, in our
opinion, the use of diagnostic labels has greater validity, both on theoretical and
empirical grounds in these areas."
On paraphilias;
"We believe that classifying these problems as ‘illnesses’ misses the relational
context of problems and the undeniable social causation of many such problems. ... of particular concern are the subjective and socially normative aspects of sexual behaviour. It is a matter of record that homosexuality used to be considered a symptom of illness. The Society would not be able to support considering sexual differences as symptoms of illness.

We, finally, have severe misgivings about the inclusion of “Paraphilic Coercive
Disorder” in the appendix. Rape is a crime, not a disorder. Such behaviours can, of
course, be understood, but we disagree that such a pattern of behaviour could be
considered a disorder, and we would have grave concerns that such views may offer
a spurious and unscientific defence to a rapist in a criminal trial."

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