1984 & DSM5, Revisited: Where Are the Social Workers?

Where are the social workers? Where are the NASW and its local and state-wide chapters? For that matter, where are the peer-run and -led advocacy and service organizations?

Over 12,000 individuals, mental health professionals and other stakeholders, have publicly declared their concern at the planned 2013 publication of the DSM5. They’ve signed the petition launched six months ago by the Society for Humanistic Psychology and the American Counseling Association requesting that the DSM5 Task Force delay finalization of the new DSM and allow a broader review of its work by professionals from disciplines other than psychiatry. Fifty-one professional organizations have also endorsed the petition … the National Association of Social Workers and its local affiliates, which represent 150,000 professional social workers, are not to be found among them.

So what’s going on with social workers? It’s almost like asking “What’s the matter with Kansas … ?” It seems like they and their professional organizations are voting against their own self-interest. Unquestioning acceptance of the DSM translates into unquestioning acceptance of the biological or medical model, which Read and colleagues have characterized as colonizing, i.e., diminishing, the psychosocial aspects of treatment — and, in the process, the relative importance of social workers. A 2008 article in the Archives of General Psychiatry describes the decline in the provision of office-based psychotherapy by psychiatrists, matched by a corresponding increase in psychopharmacology services – an apparent opportunity for social workers and psychologists, who comprise almost 90% of mental health professionals and provide the bulk of psychotherapy services nationwide. Offset, however, by the increasing proportion of outpatients who receive psychoactive medications without psychotherapy, as per the American Journal of Psychiatry (2010).

Ultimately, however, most social workers, like most Kansas voters, are not motivated by self-interest but by core values and beliefs. Their acquiescence to the DSM5 as currently composed signifies for me an abandonment of core principles – service to others; pursuit of social justice; respect for the worth of the persons being served; the importance of human relationships; and the salience of integrity and competence in social work practice (Code of Ethics @ www.socialworker.org) – and seriously undermines their fundamental mission of helping those who need it.

The Open Letter which the Society for Humanistic Psychology and the American Counseling Association addressed to the American Psychiatric Association and which serves as the preface to their petition contains a pretty comprehensive review of the DSM5 Task Force’s proposed revisions, most notorious of which include:
• lowering the threshold for mental illness, thereby increasing the likelihood of new and additional diagnoses;
• increasing the focus on children and adolescents via such novel diagnoses as Attenuated Psychosis Syndrome and Disruptive Mood Dysregulation Disorder, which appear to have little support in the clinical research literature and could well result in treatment with neuroleptic or other psychoactive medications;
• “fail[ing] to explicitly state that deviant behavior and primary conflicts between the individual and society are not mental disorders.”
• adding “grieving” that lasts for two weeks or longer to the list of criteria for Major Depressive Disorder.

To sum up the Letter’s principal concerns: “the proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks … (that) increasing the number of people who qualify for a diagnosis may lead to excessive medicalization” and increased prescription of neuroleptic medications with all their attendant risks. To which I would add … “occupiers” beware, particularly when you “occupy” the APA Convention in Philadelphia on May 5; in addition — read Joanne Cacciatore’s blog entitled “DSM5 and Ethical Relativism” that she posted on March 1 (http://drjoanne.blogspot.com) and that has attracted widespread attention: she’s been grieving the loss of loved ones for more than two years and is still sad. How crazy is that!

Finally, be aware that the DSM5 Task Force will soon announce its last public commentary period – check its website @ www.dsm5.org — after which it will begin to finalize the new edition. Accordingly, if you’re a social worker dismayed with a public mental health system in disarray, alarmed at the distortions resulting from the system’s sole reliance on the biomedical model, determined to re-commit to core social work values and promote change in a system that no longer works, here’s what you need to do:
1. read the Open Letter and sign the petition … http://www.ipetitions.com/petition/dsm5/;
2. e-mail the Board of Directors of NASW and ask them to endorse the petition … [email protected];
3. Spread the word to your social work brothers and sisters. There’s still time to put a stop to the DSM. Don’t mourn, organize!!

References:

Carney, J., “1984 Revisited: The New DSM,” posted at www.behavioral.net,
November 28, 2011

Carney, J., “1984 Revisited, II: Big Brother’s On the Run,” posted at www.behavioral.net, January 5, 2012

Frank, Thomas, What’s the Matter With Kansas?: How Conservatives Won the Heart of America, Holt and Company, New York, 2004

Read, J., Mosher, L.R., Bentall, R., eds., Models of Madness: Psychological, Social and Biological Approaches to Schizophrenia, Routledge, London & New York, 2004