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IIEHP Endorses the Open Letter to the DSM-5 Task Force!
Official Endorsement of the Society for Humanistic Psychology’s Open Letter to the DSM-5 Committee
The Institute for International Existential Humanistic Psychology offers its official endorsement of the Society for Humanistic Psychology’s (Division 32 of the American Psychological Association) Open Letter to the DSM-5 Committee and petition (http://www.ipetitions.com/petition/dsm5/). Furthermore, we applaud the Society for Humanistic Psychology for their outstanding and ongoing work on this matter. Their efforts to bring attention to the serious concerns practicing mental health professionals have with the new DSM product and process are beginning to bear fruit – both in the form of opening dialogue and increased revelation about this troubling process. Congratulations.
The work has only just begun. The petition itself has garnered more than 7000 signatures at the time of our endorsement, representing a wide swath of mental health professionals. It has also attracted media attention, not only from psychology journals and blogs but also from the national news. It has reached over half its initial goal of 10,000 signatures. Much more news coverage will be necessary to bring some sort of action from the DSM 5 committee.
The Society for Humanistic Psychology’s open letter specifically addresses concerns about how the changes proposed for the DSM-5 may particularly negatively impact vulnerable populations, such as children and the elderly. We applaud this statement, and would like to add the many groups representing various forms of diversity, including various cultural groups and sexual minorities, are also particularly at risk. Significant research and clinical evidence has indicated that these groups frequently are at greater risk of receiving diagnoses and, in particular, more severe diagnoses. The proposed lowering of diagnostic criteria for many disorders may further jeopardize these various diverse populations when seeking treatment. Additionally, it creates additional barriers to treatment through increasing the distrust of the mental health field that has all too frequently stigmatized individuals in these populations.
IIEHP, as an institution with an international focus, supports these efforts because of the potential for harm United States psychology can introduce overseas and the potential harm associated with this new version of the DSM. Thoughtlessly exporting our medical model of mental health poses serious risks overseas. Exporting only a medical model of mental health is giving the rest of the world the wrong idea about what are the best ideas and practices that America has to offer. There are many other theories and systems developed in the US, not based upon the medical model, and not prone to overpathologizing conditions. It is important for other countries hoping to learn from what the largest psychological community in the world has learned. But they need to learn that there is more than CBT and the Medical Model. Second, as the book Crazy Like US (Watters, 2010) has taught us, we need to be very careful not to assume that US practices and ethics are the best, and we need to be thoughtful and respectful of how such practices may or may not be applicable in a foreign setting. The unsubstantiated introduction of the medical model of mental health without consideration for the needs of people from other countries can result in the same sorts of over-medication, over-medicalization, and stigmatization of normal human experiences in the United States and internationally, and the DSM 5 only appears to make these problems worse.
The DSM project is predicated on an error of judgment. Correlation does not equal causation. Because there are some physical markers for some kinds of emotional distress, the medical model adherents behinds this project believe the distress is caused by those markers. This has given rise to treating normal human experience in an epidemiological manner, as though depression were one discrete illness that were transmissible through the environment and treatable with medication. The absurd notion that simple chemical fixes can favorably modify the human experience or that this would be acceptable even if it were possible has polluted the DSM 5 project since its inception.
The DSM-IV-TR has seen sufficient misuse and spawned enough international trouble. We cannot naively believe either that the creators of the new edition are innocent of undue influence from medication profiteers or that, even if this were true, the new book would not be used to further hamper the efforts of non-medical model providers. The DSM-IV-TR makes clear in its preamble that its purpose is to provide a common scientific language for discussing human problems and thus for improving the research thereof; a laudable goal which IIEHP would support if this were the complete story. It has instead been used to classify people into easy categories, limit treatment, and profit drug companies. There is no reason to believe the new version, with a more explicit emphasis on the medical model and lower diagnostic criteria, will offer anything but a worsening of these conditions.
In addition, nothing so far has been done to study the potential effects of this new publication on the international treatment of mental illness. The old version was heavily emulated in the ICD 9 and 10, and changed the experiences of many people worldwide from normal suffering, such as the Japanese experience of sadness as spiritual, into pathology, weakness, and illness. While a United States product, one must responsibly expect its ideas again will be exported worldwide and thoughtful attention must be paid to the manner in which this occurs.
The DSM committee must take seriously its responsibility that the DSM-V will be widely emulated overseas and include a warning that the data that the committee depended upon is culture specific and thus the diagnostic criteria should not be directly adopted by other countries. At best, they can only serve as a reference. This is especially relevant given that the S of DSM stands for Statistical, which means that the sampling norm is that of the United States. Using a US norm to validate construct validity, not to mention incidence and prevalence rates in other countries, is a serious ethical violation.
The US and other Developed countries have much stronger ratios of mental health professionals to the general population than the rest of the world. In fact, globally, such luxurious ratios are definitely the exception. The truth is, mental health is heavily culturally defined and for the majority of the people in the world, accessing “mental health” looks very different than it does in the US. Consider that the DSM V is published by the American Psychiatric Association, which primarily serves and represents psychiatrists. But for the majority of the people in the world, if they are “suffering” from mental health issues, they will not seek help from a psychiatrist, psychologist or even a counselor. Most people seeking to reference the DSM will probably have very little mental health training. This is a heavy responsibility indeed.
Finally, as an existential institution, we find the leap from diagnosis to treatment to be entirely too easy. To understand the human condition means first to enter into the subjective experience of the person suffering. Reams of literature support the idea that a good relationship with the purveyor of health is the most important controllable factor, and we worry that the lowered diagnostic criteria in the new edition make it entirely too easy to skip this step. The ambiguous boundary between well and ill is being slowly eroded and replaced with levels of illness that require treatment. Subjective empathy is being replaced entirely with objective classification, and the person reduced to a collection of symptoms to be eliminated.
In conclusion, we encourage everyone involved with mental health – as a professional, paraprofessional, consumer, or advocate, to read the Society for Humanistic Psychology open letter and consider adding your voice to the chorus. There is good momentum building now, and every shoulder is needed to keep things rolling in a favorable direction.
Signed on behalf of all the members of the Institute for International Existential-Humanistic Psychology.