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

Jack Carney, DSW
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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 … President@naswdc.org;
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

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Jack Carney, DSW
Up the River: A social worker, Jack Carney writes on the contradictions and hypocrisies of the public mental health system, and promotes and applauds acts of resistance to it. In the words of the immortal Joe Hill, spoken just before being executed by a Utah firing squad, he likes to advise: “Don’t mourn, organize!"

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16 COMMENTS

  1. I signed the petition and am a peer worker. I think it is of vital importance to fight what is going on with the DSM before every last one of us is caught up in the net of “mental illness” and drugged until we’re numb and don’t give a damn about anything.

    Thank you for pointing out the things that we can do to counteract biopsychiatry and the durg companies.

  2. I’m an MSW, licensed in my state to independently diagnose and provide psychotherapy. I have practiced social work for 15 years, as a clinical social worker, a supervisor and, for 9 years, a program director. I am not at all surprised at social work’s non-response to the petition.

    MSW’s have roughly the same professional standing as nurses – they generally see themselves as mid-level functionaries, not opinion leaders, academics or experts, and without the “hard” technical knowledge nurses have. And a large number of social workers feel lucky to have jobs. So, by and large, they don’t see it as their place to critically examine bio-psychiatry – they accept marching orders from those they see as in charge of those things. And having a lot of “soft” expertise, social workers like to boot strap their own sense of professional prestige by adopting bio-psychiatry’s faux scientific trappings.

    Social workers see the medical model express has already left the station, and they are well aware that lots of other people would love do their jobs if psychiatry, the drug companies and their allies decide social workers cost too much or challenge psychiatric dogma. Think substituting BSW’s in jobs held by MSW’s, or LCPC’s taking over most of the therapy, or people with degrees in Social Services or social sciences doing the case management. To protect against this, social work a) doesn’t rock the medical model boat, and b) punch up their credentials by making themselves as much like psychiatry as possible.

    I have tried for years to interest colleagues, supervisees, attendees at CEU and grand rounds presentations, leaders in NASW – and the general response is an eye rolling, “there he goes again.” I have not seen a single social work CEU presentation devoted to critically examining either the DSM or psych drugs. I’m not giving up, but it’s clear to me how strong a current I’m swimming against.

    On the positive side, social work’s “person-in-environment” and relationship-oriented focus is great and profound. The profession needs to embrace these values, stand up to bio-psychiatry and let the chips fall where they may.

    • Thanks for your commentary. Guess you’ll have to join the “do-the-right-thing” club.
      if it’s any consolation, I’ve been member from the get-go and there are more like-minded social workers out there than we might ordinarily think. I posted this to find them, and I guess I’ve found at least one. Pleasure to meet you, Peter.

  3. Bio-psychiatry is not much questioned here in Quebec, Canada. The state medias are sold to it. Mr Harper during a previous election campain had said how lucky us quebecers are to have the big pharma companies settled in Montreal, Québec.

    I am a survivor of bio-psychiatry weaned from all meds since March 2005. I never found another survivor yet here in Québec.

    I have a son who is on community treatment orders, being injected once a month for 2 or 3 years and taking resperidone and zyprexa on top.

    Sad very sad.

    The psychosocial aspect of a patient is not taken into consideration as social workers are subdued to the hierarchy, i.e. psychiatrists.

    I would have so much to tel about my story and will work on a book in the coming months…in French and in English.

    I also work on being a public speaker on this topic: surviving bio-psychiatry.

    Thanks for reading me,
    Claire Longpré
    Thetford Mines, (Québec)
    (418) 755-1742

  4. As someone diagnosed with a mental illness , I am appalled especially with the Axis II decisions regarding Personality Disorders. They are allowing people to assess others as having “some” level of PD– not necessarily full-fledged PD. If this is used- then just about everyone would be considered disordered! I was hoping that PDs would be moved to Axis I and that the term “Borderline” would finally be eliminated from the vernacular.

    Because I am a cognitive psychologist and not a clinician– could anyone tell me if the DSM is required to cite specific research studies? I haven’t seen the full DSM (just looked through the smaller manual). APA says that it is based on research, but I don’t really know the criteria. And, if I learned anything from graduate school, research evidence really is the only way we could possible draw potential conclusions about the existence of an effect (or disorder).

    As an undergrad I took Abnormal and I specifically recall my professor describing MDD as a mood disorder that could NOT be explained by the process of grief. Yes, that was many years ago, but I am shocked to learn that 2+weeks of grief could send someone down the psychiatric path! Grief is natural and can last at different intervals for different people.

    By the way, my best therapists have all been social workers!

    • Jen,

      Thanks for the reminder that social workers can be really good therapists. I think a number of social workers do chafe at the bio-model, and some fill a needed niche as really humanistic therapists. Also, like nurses, social workers often do the hard practical work that makes things happen for clients.

      My concern about social work is that while some do chafe at the medical model, few see it as their place to seriously question or act. This failure to accept responsibility and to lead needs to change.

      • Hi Peter,
        Thank you for your response.

        Yes, I could see how social workers are less encouraged to speak up. In many cases, payment is poor, there are large caseloads, and many work within the state system- so budget cuts can loom over their heads.

        I think it’s up to society and the mental health community to show social workers that they are valued. In many ways, it reminds me of the general attitude toward teachers. The respect for teachers has decreased; I am surprised people would still do it (I chose higher ed. for a reason).

        I think social workers need to feel empowered. The current climate (in my opinion) is not doing that. If the climate changes, I think social workers will be more likely to speak up for change.

    • Excellent exposition re DSM’s lack of construct validity and poor inter-rater reliability in work by Kirk & Kutchins, The Selling of DSM: The Rhetoric of Science in Psychiatry,” Aldine De Gruyter, NY, 1992 and Bentall, “Madness Explained: Psychosis & Human Nature,” Penguin, London, 2004. I also posted an article at http://www.behavioral.net on 11/28/11, where I reference both at length: “1984 Revisited: The New DSM.”
      So I guess the answer is “no” — the APA essentially asks DSM’s users to accept its contents on the APA’s authority.
      Hope this helps.