The Politics of Systems Change: Lessons Learned from the Launch of the DSM-5 Boycott

Jack Carney, DSW
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Machiavelli had it right.

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success than to take the lead in the introduction of a new order to things.”

Ever since we launched our DSM-5 Boycott three weeks ago, we’ve received support from organizations and individuals but have become entangled in more wrangling than I ever would have anticipated. While some folks have endorsed our approach and our immediate objective, curtailing the sales and the use of the new DSM, many others have criticized our tactics and strategy and have suggested we stop what we’re doing and start all over again.

Most of the comments have been pointed but civil, but a few have been personal and fierce enough to make me wince. My wife has helped keep me somewhat grounded, reminding me, as only someone who’s known me for thirty-five years can, “Well, what did you expect?” When a few sympathetic individuals attempted to commiserate over the barrage of criticisms directed my way, I tried to remain philosophical and remarked, “It seems some folks are unhappy because we haven’t declared the revolution and others because they’re afraid we might.” Another of our Boycott Committee members suggested I stop responding to the more provocative e-mails I was receiving. You know; what if they gave a war and nobody came?

That helped a lot and gave me the time to sit and reflect on what this Boycott was all about and what we might learn from the experience, whether we succeeded or failed. After all, despite years of grassroots organizing and of being a critic of the public mental health system, this was the first time I was involved in publicly challenging one of the several 800 pound gorillas that dominate the mental health system. I felt naked. We launched the Boycott, in part, just to do it, just to learn how to promote systems change on a national scale. I’m a “trial and error” guy, a partisan of the notion that nothing teaches better than failure. To quote John Gardner, “If you want to keep on learning, you must keep on risking failure.” It’s not that I anticipate we’ll fail, but I do know we’ll make mistakes and we intend to learn from them.

The wrangling hasn’t stopped, but I’ve come to see it in a different light, to view the tumult as part and parcel of getting the Boycott off the ground. It’s also an indication of our collective powerlessness, of our inability to put aside differences over tactics and unite around the paramount goal of weakening the power and prestige of the American Psychiatric Association. More on this below. Ultimately, the differing factions don’t trust one another to get the job done, and no single group has sufficient power and influence to persuade or cajole the others to follow its lead.

Outsider critics have likened us to a herd of cats – my metaphor, not the critics’ — who spend too much time and energy squabbling with one another. Actually, that’s wishful thinking on the part of the persons who made that observation. Our evident disunity is better understood as one pole or consequence of the several contradictions or dialectics in which we’re caught up and that are endemic to any social change effort. If we’re faced with any immediate task, it’s to identify those contradictions – specifically, the dialectic polarities – and address and mitigate them sufficiently to allow us to collaborate.

Michael Papa and colleagues, in Organizing for Social Change (2006), examine four social change projects that are taking place here and in India and are aimed at empowering the powerless. They identify four sets of dialectics that underpin all four to varying degrees:

• Fragmentation ←-→ Unity
• Dissemination ←-→ Dialogue
• Control ←-→ Emancipation
• Oppression ←-→ Empowerment

They also identify a meta-dialectic — Change ←-→ Permanence – which depicts the change process and provides the context for the other four. All of the four and the meta-dialectic are not “either/or” but rather “both/and” phenomena which contain tensions that are never resolved – they oscillate between the polarities and move the meta-dialectic or change process between change or stability. Should the tensions cease or diminish, movement towards change stops and whatever might have been achieved either dissipates or becomes institutionalized or permanent. Correspondingly, the group or organization that has served as the vehicle for change either ceases to exist, loses vitality or disavows its change agenda. Whatever the ultimate outcome, the tension crucial to the change process will continue its polar back-and-forth so long as it attracts a constituency committed to achieve change.

The first dialectic, fragmentation vs. unity, aptly frames the relationship between the two principal factions currently competing to lead the struggle against the DSM-5, the International DSM-5 Response Committee, whose membership is indeed international and largely British-based, and the Committee to Boycott the DSM-5, rooted in the U.S. and complemented by French and Canadian members. This is the group I helped found, along with Dan Fisher and Joanne Cacciatore, and which I currently serve as coordinator.After a week-long negotiation, both groups decided to go their separate ways, accepting the fact that personal and policy differences would not allow consolidation and would block any effective cooperation for the foreseeable future.

In dialectical terms, we opted for disunity and continued fragmentation of effort in achieving our common goals, the diminution of the sale and use of the new DSM and a corresponding loss of income, power and prestige for the APA. Practically speaking, we decided to forego what seemed fruitless discussions and to invest our time and energy in strengthening our respective Committees. On a more hopeful note, we did leave the door for eventual collaboration ajar – and some tension in the dialectic — by having several members of each Committee serve on the other. Time will tell whether our decisions were wise ones; but, as Zen-Buddhists would have it, the world is perfect as it is.

Our own Committee is less than two months old, and has slowly expanded over that time to twenty very diverse members — all opposed to the new DSM; most long-term activists; three-quarters professional practitioners; two-fifths psychiatric survivors or users of service. We’ve developed an efficient recruiting and vetting process and are always looking to expand our membership. We’ve spent much of this time focused on two inter-connected tasks: learning how to be a Committee and how to get the word out about the Boycott. Since we’re about change, the former involves negotiating the series of dialectical processes listed above – securing a Committee-wide consensus about our mission and objectives; fostering organizational cohesion; developing an internal communication system; empowering members to utilize their many skills in promoting the Boycott and their own personal growth. All ongoing works in progress, collectively aimed at enhancing our effectiveness in obtaining signatures of support and organizational endorsements of the statement that embodies our rationale for launching the Boycott in the first place. See it for yourself at http://www.ipetitions.com/petition/boycott5.

It appears that this latter task, our outreach strategy, will increasingly involve use of social media – Twitter and Facebook. Each Committee member is being asked to connect her/his accounts to the Facebook and Twitter widgets that are found on both of our two websites – the second is considered our informational site and contains the listings of Committee members and organizational co-sponsors, updates and blogs, and can be located at http://www.boycott5committee.com. The Facebook link leads to our Facebook “cause” page, the link to which can then be posted to one’s “friends”; the Twitter feed allows a link to either website to be forwarded to one’s “followers.”

Our plan is to continue to add “friends” and “followers” indefinitely and send reminders and tweets to them periodically. At the time of this posting, we’ve collected close to 900 signatures. Not very many, but we anticipate that prospective DSM-5 purchasers’ interest will be piqued as the May publication date for the new DSM draws near. Which is why we launched our Boycott initiative four months prior to the new DSM’s publication – to build momentum and a base of several thousand “friends” and “followers.”

Our aim is to obtain 100, 000 signatures by the end of this year. Yes, by the end of this year — this will be a long campaign against a powerful and dismissive foe, and we will keep the websites up and running so long as people continue to affix their signatures to the Boycott statement. And yes, 100,000, although I think we can take the next step we’re planning with a quarter of that number. Just so you know, our next step does not involve handing a petition to the American Psychiatric Association and asking them to halt publication and/or revise their new DSM. Despite its location on the ipetitions website, the Boycott statement is not a petition.

The APA has so much invested in the DSM-5 – an estimated $25 million and their prestige and credibility – that I don’t believe they’d be inclined to negotiate with anyone. No, we will use however many signatures we garner to attempt to discredit the APA and reveal it as the fraud it is. Does this constitute “anti-psychiatry?” (That phrase always reminds me of the Republicans crying “class warfare” whenever they’re obliged to defend the interests of their rich patrons.) Draw your own conclusions. Who but a madman could be “pro-“ an organization that has shamed itself and destroyed its own credibility?

As per Foster-Fishman, et al, systems change is circular, iterative and relational and involves altering existing relationships of the system’s stakeholders – the more they’re disrupted, the greater the change. Systems change is simultaneously a step-by-step process, proceeding from first order to second order change, or from a system’s more vulnerable parts to those which are entrenched and apparently intractable.

The latter requires fundamental systems change or a re-ordering of the system’s norms and values, resources, power distribution and the inter-dependence of the system’s component parts. When I look at the public mental health system, I see four institutional entities that dominate it, control its resources, and project its basic norms — the APA; Big Pharma; Big Insurance; and the Federal and state governments, particularly the U.S. Department of Health & Human Services, CMS (the Center for Medicare and Medicaid Services), NIMH and SAMHSA. The remaining stakeholders include the rest of us – provider agencies, including hospitals; practitioners, including primary care physicians, all other professionals and peer specialists; users of service; their family members, including NAMI; psychiatric survivors; advocates and activists. (I’m sure I’ve overlooked at least one presumed stakeholder – my apologies.) At present, the “rest of us,” by comparison, are disparate, divided and powerless.

Further analysis reveals that the four dominant stakeholders have succeeded in securing from virtually all of the “rest of us” — save for a few incorrigibles – agreement/acquiescence on the key defining characteristics of the existing mental health system:

• the APA’s nosology or classification of mental diseases contained in the DSM;
• the diagnostic coding system currently contained in the ICD-9 and mimicked in DSM-IV;
• the centrality of the bio-medical disease model;
• the centrality of psychoactive medications in “treatment as usual” or TAU;
• the social control function of the mental health system, as codified in State laws and Federal regulations;
• the fear and contempt of persons given serious mental illness diagnoses that permeates the system and U.S. culture.

I’ve listed the foregoing as a series of inter-connected dominoes, beginning with those elements I consider more vulnerable to first order change and proceeding with those that are fundamental to the system’s continued existence and that will require second order change. As must be evident, this is a daunting task and will require years to accomplish. Reforms, in the guise of innovative treatment approaches, are important to keep hope alive among those of us who want to see these systems changes take place; but, alone, they will not bring about lasting change since the system’s power brokers will eventually deform and co-opt the innovations.

Take it from someone who’s lived through the Federal poverty program, the Community Mental Health Center movement, and New York State’s Intensive Case Management Program and the statewide introduction of psychosocial rehabilitation ideology. Ultimately, the powerless “rest of us,” particularly those I’ve identified as “users of service” and number roughly 50 million persons in this country, have to undergo the dialectic organizing process I outlined above and transform ourselves into a potent political force.

When we launched the DSM-5 Boycott, some folks characterized our effort as a tactic aimed at costing the APA revenue and supporters. As per the foregoing, it’s also part of a strategy that dwarfs the capacity of our Committee, requires the forging of many alliances, and will need to continue beyond my lifetime. Accordingly, we consider the Boycott the first step of many. We chose to focus on the new DSM and the APA because, among the big four, the APA appears the most vulnerable. When the DSM-5 Task Force closed the books on the new DSM, the APA found itself obliged to admit that it had failed once again to gather enough evidence to support the neurobiological illness paradigm it has been attempting to establish for the past twenty-plus years.

The APA and its biological model still have no clothes and the DSM still lacks its long-awaited biomarkers. The APA had also promised to develop a “multi-dimensional” construct to add nuance to its disease classifications after discarding DSM-IV’s largely disregarded “multi-axial” methodology. Apparently, the new dimensions only managed to mystify certain members of its DSM-5 Task Force, several of whom resigned in disgust. All in all, a pretty bad turn of events for the APA, which compensated for what it had lost by adding a host of new diagnoses to the DSM-5 that will serve to pathologize the ordinary behaviors of millions of persons around the world.

As per the analysis I posited above, our next systems change step requires us to challenge the DSM’s nosology or its classification of diagnoses and presumed mental illnesses, its – and the APA’s — very reason for existing. We will proceed to do what we had considered doing when we launched the Boycott, attaching a “no-diagnosis” pledge to the Boycott and compiling a nationwide, state-by-state list of practitioners who agree not to assign diagnoses to the folks who’ve come to them for help. (In those instances where a diagnosis must be given to secure insurance reimbursement for services rendered, we will advocate Paula Caplan’s recommendation that a diagnosis be collaboratively arrived at and agreed to by the helping practitioner and the user of service.) Our fundamental contentions are that diagnoses not supported by scientific evidence but concocted to jibe with factitious illnesses are meaningless; irrelevant to the problems presented and the help required; and damaging to the self-identity of the person seeking help.

It’s at this point that our campaign, assuming we’ve gotten this far, must become overtly political. And to whom better to present all the signatures and pledges we manage to compile than to the 1000 pound gorilla of the bunch, the final arbiter of who gets paid what, the Federal Government and the Department of Health and Human Services (DHHS)? Our message will be that the APA and its DSM have lost the trust and confidence of the practitioners who are presumed to rely on the DSM to guide their efforts and of the persons they and the DSM purport to help. And what better time to do so than early next year, sometime before the ICD-10 finally goes into effect on October 1, 2014, twenty years behind the rest of the world? (For those of you who may not know, the International Classification of Diseases (ICD) is a publication of the U.N.’s World Health Organization (WHO), whose coding system has been adopted by all member nations of the U.N. via treaty to ensure uniformity of diagnosis worldwide and promote effective epidemiology and heath care delivery. It has been used in the U.S. primarily to promote uniformity of third party insurance reimbursement by Big Insurance and CMS.)

It can be anticipated that the DHHS will find itself in a vulnerable position at that time, besieged by professional organizations and provider agencies and by Big Insurance that will continue to oppose the ICD-10 until revisions favorable to their interests have been made. As Jon Abramowitz recently pointed out, ICD-10, designed by the World Health Organization (WHO) to promote better heath outcomes, will change all the current ICD-9 codes, which were designed to facilitate billing. Big Insurance and their hospital and physician allies have been fighting adoption of the ICD-10 for the past twenty years, when the rest of the world began using it. Why should they stop now?

We intend to intrude on this happy gathering, supporting DHHS’s intent to adhere to its October 1, 2014, adoption of the ICD-10, but urging that it remove from the new ICD all behavioral health codes. After all, if those codes represent factititious disease entities, they serve neither treatment nor epidemiological purposes. Why adopt them? If DHHS needs to revise the ICD-10 to address the needs of practitioners and patients in the U.S., why not revise the behavioral health codes out of the U.S. version of the new ICD? A rather ambitious undertaking, but one that, should it succeed, would alter the relationships of the biggest players in the U.S. health care system. It’s one, of course, that will require a much larger group of supporters and allies than we can currently muster and might not be able to assemble in a year’s time. Nonetheless, it would be worthwhile to put this issue before those entities – DHHS and the U.S. Congress – that have the power to make binding decisions on these matters. Remember, we’re all prisoners of hope.

Time will tell; and our involvement in the change ←-→ permanence dialectic over time will bring with it challenges and opportunities that we can’t foresee. Should we succeed in addressing these challenges, we will grow and can pursue the agenda I’ve set out above. Should we fail, so long as we remain part of the dialectic, we and others will learn and the struggle for change will continue. Support the Boycott of the DSM-5; send a message of protest to those who would impose our destiny from above. Don’t mourn, organize.

References:

Abramowitz, J., “The Road Ahead …,” “The Road Behind …,” “To Buy or Not To Buy …,”
posted, respectively, February 13, 14, 15, 2013, at http://1boringoldman.com/index.php/2013/02/13/the-road-ahead/

the road behind: paradigms that needed ending…

to buy or not to buy, that is the question…

Caplan, P., They Say You’re Crazy: How The World’s Most Powerful Psychiatrists Decide Who’s Normal, Perseus Books, 1995

Centers for Disease Control and Prevention, “Health, United States, 2011,” http://www.cdc.gov/nchs/hus/mentalhealth.htm

Chan, A., “1 in 5 U.S. Adults Had Mental Illness Last Year: Report,” January 19, 2012,
http://www.huffingtonpost.com/2012/01/19/mental-illness-united-states-_n_1216575.html

Foster-Fishman, P., at al, “Putting the System Back Into Systems Change: A Framework For Understanding And Changing Organizational And Community Systems,” American Journal of Community Psychology, Vol., 39, pp. 197-215, published online, May 18, 2007, Springer Science+Business Media, LLC 2007

Frances, A., “How Many Billions a Year Will the DSM-5 Cost?,” December 20, 2012,
http://www.bloomberg.com/news/2012-12-20/how-many-billions-a-year-will-the-dsm-5-cost-.html

Frances, A., “Price Gouging: Why Will DSM 5 Cost $199 a Copy?,” January 23, 2013, http://www.psychologytoday.com/blog/dsm5-in-distress/201301/price-gouging-why-will-dsm-5-cost-199-copy/

Jabr, F., “The Newest Edition of Psychiatry’s ‘Bible,’ the DSM-5, Is Complete,” January 28, 2013, http://www.scientificamerican.com/article.cfm?id=dsm-5-updates&WT.mc_id=SA_CAT_MB_20130130

Macchiavelli, N., http://creatingminds.org/quotes/change.htm

NCHICA ICD-10 Taskforce, “Health Care Reform & ICD-10 CM,” September, 2011, www.nchica.org

Papa, M., et al, Organizing for Social Change: A Dialectic Journey of Theory and Praxis, Sage Publications, New Delhi, Thousand Oaks, London, 2006

Spencer, J.P., “A Requiem for ICD-11 …,” posted May 18, 2012, At http://www.firmed.com/blog/2012/05/18/requiem-for-icd-11-perspective-on-physician-compensation/

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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!"

17 COMMENTS

  1. Thanks for this post. As a member of the International DSM Response Committee I can concur that the discussions have sometimes been difficult, and I sympathise about the personal impact this has had on you – it is always difficult to stick your head above the parapet, but please don’t give up!

    From my perspective, the discussions have highlighted (at least) 2 areas of difference:

    1) The US position vs that in other countries, specifically the UK. I am not used to thinking of myself as in a fortunate position in relation to dominance of psychiatric diagnosis, but it is obviously a huge advantage not (yet) to have the US billing system, and not to have salaries dependent on it. As an individual clinical psychologist, there is virtually no situation where I am absolutely required to use a diagnosis, although of course the mental health system itself is based on such terminology. For this reason, the wish to deprive DSM of its revenue etc perhaps seems less urgent for us.

    2)The lack of an agreed and coherent critique of diagnosis in principle, aside from the specific issues relating to DSM 5. Clearly, not all the campaigners have objections to diagnosis per se. This is very frustrating for those of us who take what has been described as a ‘radical’ (my translation: absolutely obvious and common sense) view. Again, in the UK I think we are further ahead on this issue. The Critical Psychiatry group rejects the use of psychiatric diagnosis, and the robust response to the DSM 5 revisions by the British Psychological Society in 2011 took the same position. The official UK Clinical Psychology guidelines on psychological formulation state that it should ‘not be premised on a functional psychiatric diagnosis such as schizophrenia or personality disorder’) (DCP 2011.) A ‘Position Statement on Classification’ is currently under preparation by the UK Division of Clinical Psychology, and is likely to echo the above views. I have discussed all these issues in more detail in my blogs on this site.

    So, for various reasons it may be right to work separately but alongside each other at present as we try to reach our common goal. Keep up the good work!

    Incidentally, I have had some success in persuading UK psychiatrists to use the catch-all term ‘adjustment disorder’ if they have to supply a diagnosis. That can apply to absolutely all of us!

  2. A great essay Jack, articulating the seemingly immpossible task fo “affecting” system change. I note the rather “dry” intellectual understanding of systems of human interaction though;

    “As per Foster-Fishman, et al, systems change is circular, iterative and relational and involves altering existing relationships of the system’s stakeholders – the more they’re disrupted, the greater the change. Systems change is simultaneously a step-by-step process, proceeding from first order to second order change, or from a system’s more vulnerable parts to those which are entrenched and apparently intractable.”

    And call your attention to the “subconscious” nature of human motivation, in what is essentially an “emotional” system. Please consider Murray Bowen’s older, but very valid views on the issues plaguing this rather intellectual view;

    “The societal projection process: The family projection process is as vigorous in society as it is in the family. The essential ingredients are anxiety and three people. Two people get together and enhance their functioning at the expense of a third, the “scapegoated” one. Social scientists use the word scapegoat , I prefer the term “projection process,” to indicate a reciprocal process in which the twosome can force the third into submission, or the process is more mutual, or the third can force the other two to treat him as inferior.

    The biggest group of societal scapegoats are the hundreds of thousands of mental patients in institutions. People can be held there against their wishes, or stay voluntarily, or they can force society to keep them there as objects of pity. All society gains something from the benevolent posture to this segment of people. A fair percentage of people are too impaired to ever exist outside the institution where they will remain for life as permanently impaired objects of the projection process.

    The conventional steps in the examination, diagnosis, hospitalization, and treatment of “mental patients” are so fixed as a part of medicine, psychiatry, and all interlocking medical, legal, and social systems that change is difficult. There are other projection processes. Society is creating more ‘patients” of people with dysfunctions whose dysfunctions are a product of the projection process. Alcoholism is a good example. At the very time alcoholism was being understood as the product of family relationships, the concept of ‘alcoholism as a disease” finally came into general acceptance.

    There might be some advantage to treating it as a disease rather than a social offense, but labeling with a diagnosis invokes the ills of the societal projection process, it helps fix the problem in the patient, and it absolves the family and society of their contribution. Other categories of functional dysfunctions are in the process of being called sickness. The total trend is seen as the product of a lower level of self in society. If, and when, society pulls up to a higher level of functioning such issues will be automatically modified to fit the new level of differentation. To debate such a specific issue in society, with the amount of intense emotion in the issue, would result in non-productive polarization and further fixation of current policy and procedures.

    The most vulnerable new groups for objects of the projection process are probably welfare recipients and the poor. These groups fit the best criteria for long term, anxiety relieving projection. They are vulnerable to become the pitiful objects of the benevolent, over sympathetic segment of society that improves its functioning at the expense of the pitiful. Just as the least adequate child in a family can become more impaired when he becomes an object of pity and over sympathetic help from the family, so can the lowest segment of society be chronically impaired by the very attention designed to help. No matter how good the principle behind such programs, it is essentially impossible to implement them without the built-in complications of the projection process.” _Murray Bowen.

    The common man/woman tends to decry “the system” as if the system is an external reality totally separate from their own subconscious motivations. Yet when we view society from Bowen’s emotional systems perspective, particularly its Paternalistic and Condescending nature, we may come to understand the subconscious motivations involved in what appears, on the surface, to be an “objective and rational” debate.

    Best wishes,

    David Bates.

  3. Yes, it’s a long struggle – sigh.

    Yes, conflict with chums is difficult – tripple sigh.

    Yes, I agree with Lucy J, things do seem different in the UK, but I also think the initiative you have started is extremely valuable.

    What I perticularly liked was the way you had thought out in your strategy how different players could involve themselves in this at different levels of risk and involvementover a long term while also leaving room for innovation in the campaign. Hopefully that will create a bit of movement buidling.

  4. The best way to fix any system that is fraudelent, arrogant and tyrannical is to end it completely and start all over. Trying to change a system that is so inhumane as the psychiatric/pharmaceutical/government complex is a waste of time in my view. The only way to change anything is from the grassroots level. Get the grassroots level angry enough and many things can change overnight. Psychiatric survivor groups are sprouting up everywhere, though I haven’t seen any groups (except those headed by ghostwriters)applauding the treatment they received at the hands of psychiatrists and the mental health scheme. I feel we have to make more people aware of the truth about psychiatric treatment so they will stand up for themselves and refuse it, as it is their right…then things will change. As well, I feel it is long past time that Dr. Peter Breggin be nominated for a Nobel Peace Prize. AFter all, the doctor who found a way to quickly brain damage millions with icepick lobotomies won a prize.

    If someone like Dr. Breggin won such a prize, we would immediately have the ear and attention of billions of people world-wide.

  5. To Jack Carney, I like the way you think. As I read your strategy, I thought it read like a it could inspire a movie script. Truth is stranger than fiction. Maybe it’ll it be much better than a movie script because it’ll be a documentary as to how it was done.

  6. “Fear is Not a Mental Disorder”
    I am a practicing clinical psychologist who wholeheartedly supports a boycott of DSM-5. I have for years believed that the DSM is inaccurate and misleading in fundamental ways and could even be considered harmful to clients. The mythology of the DSM has for decades hindered therapeutic treatment of clients, and generally complicated what are very simple, understandable concepts that underlie human behavior.
    I have written a blog post and essay on http://www.PackLeaderPsychology.com that takes a broad, philosophical look at concerns about the DSM. I believe, as many do, that the time is right to completely re-conceptualize diagnostic strategies from the ground up, with the goal of developing a replacement for the DSM.
    In my essay, I present a powerful and concise theoretical framework to use when diagnosing human behavioral and emotional distresses. This new paradigm is explained in depth in my book Pack Leader Psychology. This paradigm offers numerous benefits not found in the DSM, corrects many of the theoretical errors in the DSM, and provides an effective diagnostic and therapeutic solution.
    Pack Leader Psychology is based on indisputable facts, not the unscientific, confusing, and complex “system” of “diagnostics” of the DSM. Most important, the Pack Leader Psychology model brings numerous benefits to clients. Where the DSM pathologizes human behaviors as illnesses and disorders, Pack Leader Psychology offers an innovative paradigm that explains these behaviors as normal, natural responses to perceived or real threats and fears. Pack Leader Psychology is a more positive, optimistic, and straightforward framework that strips away harmful, judgmental labels and de-stigmatizes “mental illness” in a profound and fundamental way.
    Quite simply, Pack Leader Psychology is based on this concept: The majority of “mental disorders” that people experience are due to the primal fear response. Fear is not a disorder, but a normal, adaptive human reaction.
    I’d love to hear any feedback on my essay! Thanks!