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A Revolutionary Alternative to Psychiatric Diagnosis

Welcome to From Insults to Respect.

Regular readers know that I have, from time to time, been dealing with a conflict regarding psychiatric diagnosis. Said briefly, there are many people who immediately lose respect for anyone who questions the validity of the mental illness/mental disorder theoretical construct. On the other hand, many people have lost respect for the psychiatric profession because of its pathologizing approach of addressing concerns related to thinking, mood, behavior, or challenging life situations. Amidst this conflict, I have been trying to put forth on this blog, and in a number of other publishing outlets, an alternative approach with which the disputing parties can live in relative peace.  

Last year, I presented a paper on this topic at the American Psychological Association convention in Denver (see HERE). That paper defended my alternative approach by focusing on the reasons it would, when compared to the current psychiatric approach, be more respectful, beneficial, and fairer to those seeking mental health services while being just as practical for mental health service providers.  This year, I will soon (8/5/17) be presenting a paper at the American Psychological Association Convention in Washington D.C. on this topic, but this time I plan to focus on the scientific merits of my alternative. I am hoping to get some feedback about my preliminary draft. So, if you will, please take a look at it. All are encouraged to provide suggestions for improvement or to raise any questions.

My Speech

Albert Einstein created a revolution in the branch of science known as physics. Prior to the 20th century, physicists explained the propagation of light with the use of a theoretical construct known as the ether. There were experts in the ether who described ways to define it, along with its various characteristics. It was thought, for example, that the ether didn’t move in any direction, but it could vibrate. There was much discussion about an ether wind. And then Einstein came along and described the nature of light without resorting at all to the ether.

There was a great deal of resistance to Einstein’s theory at first, but in time his theory came to be accepted as a distinct improvement. Today I want to make the case that the theoretical construct known as mental disorder is the ether of psychology. Here’s a little of what I mean by that.

For a long time now, when people seek to access mental health services, they find that in most settings the concern they want addressed must be converted into mental disorder terminology. In the United States, the text used for this purpose is typically the DSM.

Criticism of the mental disorder construct began at the very beginning of American psychology when William James declared that it was nothing more than superficial medical talk. Criticism continued throughout the 20th century, and when the latest version of the DSM came out, there was a ton of media and professional articles that once again pointed out its numerous scientific shortcomings. Many throughout general psychology expressed deep concerns that psychologists utilizing the DSM approach had sold out to psychiatry and the pharmaceutical industry. Moreover, they bitterly complained that a paradigm that utilizes the mental disorder construct brings down respect for psychology as a legitimate branch of science. What can be done about this?

Well, in thinking about this I hasten to mention that Thomas Kuhn’s (1972) classic book, The Structure of Scientific Revolutions, rightly points out, for real change to occur in a branch of science, it is not enough to point out the weaknesses of a paradigm, there needs, as well, a new approach that is a distinct improvement over the old paradigm. So, is it possible to really come up with a distinct improvement over the current DSM approach? I think our APA can do this easily if it set its mind to it, and it can do so within a year.

What would this new approach look like? Well, for your consideration, I offer you the Classification and Statistical Manual of Mental Health Concerns, or, for short, the CSM. Let’s look at a summary of what it would contain.

It would begin with the following statement:

“The developers of the CSM fully recognize that individuality outruns any classification system. It is for this reason that the CSM does not seek to classify anyone. Instead, it classifies the expressed concerns of individuals seeking to have their concerns addressed by a mental health service provider.”

Now think about this for a moment. The expression of a mental health concern is a clearly observable event that occurs at a specific time and place. Thus, by making it the event being classified, it beautifully solves the reliability problems that have been plaguing the DSM’s far more abstract theoretical construct of “mental disorder.”

Here’s the CSM’s definition of its main construct:

A mental health concern occurs when a person seeking mental health services expresses to a mental health service provider a concern about thinking, mood, behavior or challenging life situation.

That’s it—that’s its definition. If a service provider is not certain if a mental health concern has been expressed, he or she could easily verify that it has indeed occurred. Here’s a simple example of what that would look like.

Let’s say Mary Doe comes to a licensed practicing psychologist and says she has been feeling a great deal of sadness much of her days. The psychologist, for verification purposes can say, “I hear you saying that you are concerned about how sad you have been feeling much of your days, and you would like us to work together to address this concern, is that correct?” If the service seeker says yes, this would verify that a mental health concern has been expressed, and what the concern is.

In the CSM, the various concerns would be provided, along with a code for insurance company record keeping. Concerns that would be included in the first edition of the CSM would be selected empirically from survey data that asks practicing psychologists to identify the types of concerns they were asked to address in their practice over the past year, but to avoid utilizing pathologizing words.

The creation of the CSM would provide a common, jargon-free language for mental health service providers that utilizes a distinctly more scientific alternative than the DSM approach. It would stimulate research programs that compare outcomes for services that utilized the DSM approach with that of the CSM approach. Moreover, it would provide a new choice to mental health service consumers, challenge old ideas, and stimulate fresh perspectives.

The scientific merits of the CSM approach, when compared to the DSM approach are numerous. Unfortunately, there is not enough time here to go into them in any detail. For those of you who are interested in the details, you can readily find an article that I recently wrote that is now published in The Journal of Humanistic Psychology. Up on the screen is the reference. [Click HERE to access the journal article]

Call for Feedback

Well, there you have it. I only have seven minutes to present the paper, so many of the essential points that I would love to make have to be left out. There will be some time for questions and discussion, so some additional information could be shared then. And, for those who are interested, as I point out in my paper, they can now readily retrieve a far more complete presentation of my proposal by assessing the journal article I wrote that was just published last month.

Chiefly, my objective in presenting my paper at this year’s APA convention is to stir up the interest of as many psychologists as I can in the hope that a coalition will begin to form that can lead us toward making a significant improvement in the state of the current conflict. Again, I urge readers to let me know their thoughts on this topic, and to make any suggestions they would like aimed at improving my presentation.

Is President Trump Mentally Ill?
APA 2017 Speech on Psychiatric Diagnoses

About the Author

Jeffrey Rubin grew up in Brooklyn, received his PhD from the University of Minnesota and has taught conflict resolution there as well as at a psychiatric clinic, a correctional facility and a number of public schools. He has published articles on anger and conflict resolution and has authored three novels.

7 Comments

  1. I agree with you fully. A diagnosis makes everyone see themselves an others as this is who they are and leads people to resign to that.
    These things are learned behaviour and old emotions but not the person. I am just fine.

  2. I think some bad motives for psychiatric diagnoses are:
    – demand for specific social services.
    – deculpabilize mind-altering addictive chemicals prescription and consommation.
    – simple defamation.
    – mask an underlying conflict at the origin of the demand or gag a person.
    – provide some justification for depriving someone from their human rights.
    – serve medical power or industrial pharmaceutical interests.

    Simply consider: to be fertile is not a pathology, yet, you may prescribe drug for the condition. I think the whole diagnostic-treatment concept is inappropriate for psycho-social demand.

    May be we should focus on the demand, as an economical term.
    A demand has at leat two entities involved. To put a diagnosis on one part is to take one’s side against the other: this is unethical.

    First ask the person themselves, not the family, nor society agents: how could we help you ?
    The answer may be: “Just leave me alone.” You have to do just that.

    There are good insights from the Open Dialogue approach to the appropriate answer to psychosis situations.

    What is psychosis ? Historically, the “diagnostic” a patient received in forced psychiatry asylum, when he refused to cooperate. That psychosis was a conflict about lack of understanding and respect for the rights of a person.

    To be diagnosed is to be juged a culprit when innocent of a crime, with no trial and no jury: this has to stop.

  3. As a recovering TBI sufferer, I concur with your approach. I cannot prove that there are intermittent gaps in my memory, but they are such that I, as a former business owner, could not imagine a type of employment that could be satisfied by an employee who, when asked “Did you do such-and-such?” simply could not be certain if the answer was yes or no. Forgetting to take out the trash is one thing, forgetting to make a call to 911 in the event of an emergency is quite another. I cannot anticipate what event, instruction, or bit of information I will forget, nor can I tell if it will remain forgotten, or come back with some kind of reminder. But I do know that I forget things, and it concerns me, and I would like help with that, but as I can’t quantify it, I can’t get it recognised. Perhaps if I seek help with my concern, rather than the object of my concern, I will be better served. I’m going to try it – I have an appointment to establish care with a physician (alas, the closest thing to a “mental” heath provider in my area) on Monday. I can let you know how effective that approach is – if I can remember! 😉

  4. Good luck on your speech
    My comments are as follows (from a laymens perspective)
    1. With only 7 minutes I would shorten or eliminate the Einstein story. Your educated audience should not need too much explanation of your goal
    2. A simple graphic highlighting the pluses and minus of your approach vs the traditional rubric might be helpful and provide a one page takeaway for further consideration at a later time

    • Hi John Whyte,

      Thanks for your thoughtful comment on this topic–very much appreciated. After writing this draft, I was informed that I had not 7 minutes, but 10 minutes, so I think I did get in a little more of what you see as essential. Moreover, during the discussion period after my presentation, even more was provided.

      It difficult for me to explain why I felt that the Einstein story was so important to include other then to say that the sponsoring group for my speech has a journal that really values making psychology a legitimate branch of science, and the work of Thomas Kuhn on scientific revolutions was highlighted in a recent paper published in APA’s flagship journal. Connecting with these journal articles just makes sense to me. In any case, my next blog post that you should see soon presents the final draft of what I presented, so it will be interested to get your reaction to it.
      My Best,
      Jeff

  5. Dr Rubin,
    I enjoyed your article and hope your speech went well. It all makes sense to me.

    • Always a pleasure to hear from you, Mary Whyte. Much thanks for your kind words of support. The speech did go well, and judging from the warm round of applause, I think the audience members found some value in it.
      Warm Regards,
      Jeff

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