UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the 'Disease' Model

[bananas]

The actual position statement is at http://www.madinamerica.com/wp-content/uploads/2013/05/DCP-Position-Statement-on-Classification.pdf

Here are excerpts from an explanation by one of it's authors:

http://www.madinamerica.com/2013/05/uk-clinical-psychologists-call-for-the-abandonment-of-psychiatric-diagnosis-and-the-disease-model/

UK Clinical Psychologists Call for the Abandonment of Psychiatric Diagnosis and the ‘Disease’ Model

Lucy Johnstone
May 13, 2013

In a bold and unprecedented move for any professional body, the UK Division of Clinical Psychology, a sub-division of the British Psychological Society, issued a Position Statement today calling for the end of the unevidenced biomedical model implied by psychiatric diagnosis. The key message of the statement is:

“The DCP is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations. Consequently, there is a need for a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system not based on a ‘disease’ model.”

In brief, the argument is that the so-called ‘functional’ diagnoses – schizophrenia, bipolar disorder, personality disorder, ADHD and so on – are not scientifically valid categories and are often damaging in practice. The statement argues that we already have alternatives, such as psychological formulation, and that there is a need to work in partnership with service users and professional groups, including psychiatrists, in order to develop these further.

The story made the front page of ... <snip>

Needless to say, there has been as much backlash as appreciation. ... <snip>

The actual statement makes it absolutely clear that these are misrepresentations. The DCP specifically states that ‘This position should not be read as a denial of the role of biology in mediating and enabling all forms of human experience, behaviour and distress.’ The statement also explicitly says that the argument is about ways of thinking, not about particular professions. The ‘turf wars’ accusation is particularly wide of the mark given that the DCP statement is simply a more measured reiteration of recent comments by some of the world’s most eminent psychiatrists: Allen Frances himself described DSM-5 as ‘deeply flawed and scientifically unsound’, while Dr Thomas Insel, NIMH director, said ‘Patients…deserve better’. Former NIMH director Dr Steven Hyman, was even blunter: he called DSM-5 ‘totally wrong, an absolute scientific nightmare’ and in response, the Chair of the DSM-5 committee, Dr David Kupfer, admitted “We’ve been telling patients for several decades that we are waiting for biomarkers. We’re still waiting.”

The main difference – and of course it is a crucial one – between the position of these eminent psychiatrists and the DCP is that the former are determined to pursue the biomedical model at all costs. Indeed, NIMH has (as discussed on this site) announced the intention of launching a 10-year programme to pin down, once and for all, the elusive biomarkers that have evaded researchers so far. The project starts from the remarkably unscientific position of assuming what needs to be proved: in their words that ‘mental disorders are biological disorders.’ Flawed as this enterprise is, it will allow traditionalists to continue to claim that ‘We’re getting there – honestly!’ In the meantime, the overwhelming amount of evidence for psychosocial causal factors is once again relegated to a back seat.

<snip>

[Tobin S.]

1. My medication makes me sane. What does it change when I take it?

[Neoma]

2. I don't think they're denying its biological though.

Seems like they're pushing to not call it a disease...

[Tobin S.]

3. Ah

I don't know what else it would be.

On the surface it just appears to me that some psychologists are worried that they'll be losing work because more people might seek drug therapy for treatment of their mental health problems. There's probably more to it than that, I guess.

There is a time and a place for both kinds of therapy, and what I've heard from most mental health professionals is that they usually recommend doing both if you have a moderate to serious illness.

[HereSince1628]

4. IMO this is largely about conflicting views of clinical psychology.

Last edited Sat May 18, 2013, 05:16 PM - Edit history (1)

Historically clinical psychology has divided itself into various camps/schools/approaches (google history of psychology for an introduction into that). The outcomes of both the APA vote (that adopted changes in the DSM and voted to publish DSM-5 four days from today) and the vote of the UK's Division of Clinical Psychology (that adopted the position the story is based on) are reflections of the balance of political power of the various camps/schools/approaches among the memberships of the APA and the DCP.

Fifty years ago, Kuhn criticized psychology in general as remaining immature because it hadn't found an over-arching paradigm to guide itself. Such paradigms exist in physical science and in biology. In chemistry, the concept of the atom guides both research and explanations. In biology, as Dobzansky said...nothing makes sense except in the light of evolution. For biologists, phenomena as diverse as biochemical activity of genetic expression and biotic diversity of ecosystems all 'fit together' and philosophical orientations as opposed as biological reductionism and biological integrationism neatly reconcile within the paradigm of evolution.

Fifty years after Kuhn's comment, clinical psychology remains without an over-arching paradigm. Which isn't to say psychiatry/psychology has been standing still. In the US, in recent decades the neurobiologists have certainly been on the move employing powerful developments in imaging and molecular biology. Recently that has become too much political success within the discipline for the liking of clinical psychologists outside of the neurobiological view. The positions taken by NIMH on research funding and Obama on 'brain mapping" are part and parcel of that success. A level of success that is likely to be provoking to the non-neurobiologists and especially so to those whose views are opposed to structural/physiological reductionism.

Despite protestations within the quote, the Guardian story can't be extracted from the conflict/struggle within psychology. Critical reading is important to understanding this story and other stories dissing the DSM-5 and biological/medical approaches to psychology. Critical reading requires considering both what and how something is said, and just as importantly what is selectively not said at all.

Just as politics has indicative buzzwords, so too does psychology. Understanding where the comments in the story come from require running down which groups use which buzz words. The link below is to a PowerPoint that includes criticism of the medical model, a.k.a. disease model, of clinical psychology. That PP will give the viewer some insight into the rhetoric of the conflict among the "schools".

There is also information behind this story that is going unsaid...left in between the lines if you will. The article is critical of indexes of mental illness such as the DSM (Diagnostic and Statistical Manual) and the ICD (International Statistical Classification of Diseases and Related Health Problems) but the article doesn't mention and isn't at all critical of the PDM (Psychodynamic Diagnostic Manual). Is that just a coincidence? Maybe, maybe not. Granted, it's always a risky thing to make specific claims about intentionality and meaning of that which goes unsaid. But, just as sculpture is understood by the 'negative space' it defines, point of view is also enriched by understanding what is not said and what is endorsed by not being included in criticism.


http://www.google.com/url?sa=t&rct=j&q=psychodynamic%20criticism%20of%20medical%20model&source=web&cd=1&cad=rja&ved=0CCsQFjAA&url=http%3A%2F%2Fwww.howiefine.com%2FHealth%2FHealth%2520Week%25203%2520Health%2520Models%2520cont.pdf&ei=EW-XUZLgKKmuyQGWv4HwDA&usg=AFQjCNEHTblAQO7GC-m0C-6DJ1a0RvcHOw