The petition against the DSM-5

[M Winther]

There is an "Open Letter to the DSM-5", but it is unsatisfactory.
http://www.ipetitions.com/petition/dsm5/

The problem is that the document is divided into several points.
Although one is inclined to agree with certain points, one could
differ in others. If that's the case, then one cannot underwrite this
document. For instance, it is stated that "[the] proposed
reclassification of [ADHD] to the new grouping "Neurodevelopmental
Disorders" seems to suggests that ADHD has a definitive neurological
basis."

But today the evidence is mounting that ADHD develops due to prenatal
exposure to alcohol, maternal stress, or early life exposure to
damaging chemicals and certain foods, coupled with genetic
sensitivity. Such factors affect the neurological development in the
brain. It seems like the classification "Neurodevelopmental Disorder"
is apt. This doesn't mean that it isn't treatable in therapy.

One cannot expect all psychotherapists to agree with all these points.
Another difficulty is this one: "The putative diagnoses presented in
DSM-V are clearly based largely on social norms, with 'symptoms' that
all rely on subjective judgments, with little confirmatory physical
'signs' or evidence of biological causation. The criteria are not
value-free, but rather reflect current normative social expectations."

Arguably, normative values are very central in diagnosis. For
instance, the behaviour of the individual involved in a narcissistic
group, e.g. a Masonic Order, or a mafia organization, can be diagnosed
as acutely narcissistic. However, if we adopt a perspective from
within group narcissism, he is well-adapted and therefore perfectly
normal. On the other hand, a "normal" individual fares awkwardly in
the narcissistic coterie. He would soon develop "neurotic symptoms"
and, typically, diffuse symptoms to the stomach.

In such case, a psychoanalyst must maintain a value-based evaluation
of disease and conclude that it is the apparently "healthy"
individuals that suffer from pathology, and the "sick" individual is
inherently healthy, he only needs to leave the narcissistic group. But
it seems like this document furthers a morally relativistic
perspective, irreconcilable with psychoanalysis. Morals is part and
parcel of the human condition and hence also of psychoanalysis.

During Germany's Third Reich many men belonging to the elite came to
the doctors with diffuse symptoms, especially to the stomach. These
were the supposed Aryan supermen who proved to be sick and weak. It
amounted to a virtual epidemic. Of course, these were neurotic
symptoms. The unconscious reacted against the monumental immoral
condition of society and the weird ideas of a superhuman elite.
According to an "objective" evaluation, these people suffered from
some form of mental condition, and should be assigned a DSM code. But
from a "morally biased" evaluation, they weren't sick - it was society
that was sick.

So we mustn't overvalue "confirmatory physical 'signs' or evidence of
biological causation". This is also the shortcoming of the so called
"mental health revolution":
http://tinyurl.com/bn9xv8e
They say that they take psychiatric diagnosis away from the
descriptive and from the talking cure, to a cure based on deeper
biology - lab tests or blood tests. Mental health is rapidly becoming
a field of medicine just like any other. "If something goes wrong,
clinicians will apply a battery of tests, make a diagnosis and decide
on the best treatment for an individual."

Of course, if we were able to apply this knowledge on the Aryan elite
of the Third Reich, the clinicians would soon be able to discover what
chemicals and neurons are failing, and correct it by prescibing some
compound suitable for the individual. Thus they could return to their
duties as superhumans. According to this view, there is no psychic or
social backdrop to the illness. It is only a malfunctioning neural
system. This is the "objective" and "scientific" view of the current
mental health revolution, which is completely amoral. It is the public
medical service of George Orwell's 1984.

The "Open Letter to the DSM-5" makes this formulation: »An ideal
empirical system for classification would not be based on past theory
but rather would "begin from the bottom up - starting with specific
experiences, problems or 'symptoms' or 'complaints'"«

Obviously, it doesn't work that way. The symptom as such is not that
relevant. It is the psychological and sociological backdrop which is
relevant, something which necessitates a talking cure. It is better to
apply a diagnose "bad marriage" than to observe a patient and conclude
that he suffers from the "splitting headache syndrome".

Of course, everybody must realize that such a bottom-up classificatory
system is perfectly silly. This document shows the Society for
Humanistic Psychology in a bad light. It reveals a lack of
psychological understanding. The DSM certainly deserves critique, but
this document is not good enough.

Mats Winther
http://home7.swipnet.se/~w-73784/