Are Psychologists Behaving Unethically By Using the DSM?

Rob Wipond
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Many psychologists do not believe the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders is scientifically valid, reliable or even helpful, according to a study in the Journal of Humanistic Psychology. So when those same psychologists admit that they nevertheless continue to use the DSM for financial reasons, asked the researchers, is that not a violation of their most basic ethics?

Two State University of New York psychologists surveyed 104 psychologists about their use of and attitudes about the Diagnostic and Statistical Manual of Mental Disorders. They found that the psychologists’ perspectives were “significantly more negative than neutral.”

The psychologists identified some of the DSM’s problems: “obscures individual differences” (60.58%), “places more emphasis on diagnosis than treatment” (51.92%), “places too much emphasis on pathology” (50.96%), “labels distort one’s perception of a client” (43.27%), “applies medical labels to psychosocial problems” (43.27%), “has little bearing on treatment” (31.73%), “not reliable” (29.81%), “other” (22.12%), “not valid” (19.23%), and “diagnostic classification often leads to inappropriate treatment” (18.27%).

Yet 90% admitted that they still use the DSM regularly, primarily because it is accepted as a framework for billing.

“Finally, ethical concerns remain, with the question being whether it is appropriate for psychologists who have concerns about the scientific status of the DSM to continue using it,” wrote the researchers. “Professional ethics forbids the use of instruments one does not believe to be valid, yet the results of the current survey suggest that most psychologists are using the DSM as a means to collect insurance payments.”

Raskin, Jonathan D., and Michael C. Gayle. “DSM-5 Do Psychologists Really Want an Alternative?” Journal of Humanistic Psychology, March 22, 2015, 0022167815577897. doi:10.1177/0022167815577897. (Abstract)

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8 COMMENTS

  1. My pal a neuro-psychologist, used to work in the state system, has friends from UCLA to UC Davis, uh. He used to train psychiatrists at a major university as a psychologist and specialist in psychopharmacology. He told me DSM-5 is basically a fraud. He works with a team psychiatrists who believe the same. There’s movements around the country to see if DSM-5 can be fixed. DSM-5 is believed by him that, they added so many new diagnosis, and they lifted previous good restrictions on the way drugs should be prescribed. The goal seems to be to prescribe drugs to every condition in the DSM-5, even personality disorders and autism. They’re expecting when DSM-5 officially takes over this year that an uprise in the amount of prescriptions for drugs will take place.

    The team behind the DSM-4 apparently had nothing to do with the DSM-5 is another issue.

    They’ve muddied the waters. Apparently DSM-5 is largely backed by insurance companies and doctors seeking profits.

    There’s a reason this takes place. The more prescriptions, the more care provided, the richer the powers that be get. Precisely the issue is, drugs are patented, and investors are seeking to profit drive the system and get even more returns. They’ve basically pathed the way for this to happen and made investments to make it so.

    W/ insurance companies backing it, the reason behind that is the more care they sell, the more prescriptions, the more money they get. That’s because the Affordable Health Care Act limits profits to a percentage spent on healthcare, so what you’re going to see is health insurance companies pushing to sell treatment to people in order to boost the margin they get to keep as profits. To them, the more prescriptions made, the better. There’s a chance the insurance companies get more kick back from prescriptions than from say prescription of psychotherapy and other treatments, given that the insurance companies act as middle man for drug prescriptions and drug companies are stock based and can kick some of their profits back to other interested parties but psychotherapist actually are just getting paid their agreed to rates and fees with no investors and generally no way to do kickbacks. There’s room for negotiations and kick-backs with the drug companies, “$2000.00/yr of this insurance subscribers health benefits will go to the drug companies,” is actually a goal they have – as the money lands into the drug companies hands, middle men, etc it can be disbursed from there to involved participants. The more people they get doing that. the more money the insurance companies collect on fees with perhaps kickbacks or even investments making returns. Also in the ACA as I said, they created a ratio of patient care to profits, of 80:20. To increase the 20% pie proportionately they have to increase the 80% pie and increasing the amount of people prescribed drugs is a good way to do that.
    http://poorrichardsnews.com/post/27741944573/obamacare-caps-the-profit-health-insurance
    http://www.oregonstatehospital.net

  2. “Are Psychologists Behaving Unethically By Using the DSM?” Since Dr. Thomas Insel has confessed that there is no scientific validity to any of the disorders within the DSM, and defamation of character is still technically illegal, the answer is Yes.

    “The finding that almost all psychologists use the DSM despite serious concerns about it raises ethical issues because professionals are ethically bound to only use instruments in which they are scientifically confident.”

  3. I personally don’t think of a full time job in the mental health profession as recovery from the depredations of the mental health profession. It is, as this article shows, corrupt from top to bottom. Expanding that profession is not a beneficial end in my book. If we could cure people of the mental health profession, then we’d be making progress.

  4. Thanks for posting Rob Wipond, is a great topic. I get they are stuck between a rock and a hard place as they have to be paid if they are going to practice (not accepting insurance means they cannot help many who need the service the most… just those who are well off and can pay out of pocket) – and at least the fact they speak out openly about why they oppose the current DSMV and would like to change it to make better is positive.

    I’ve just joined MAD a month or so ago, can’t believe how much I have learned, is a great resource.

  5. I was forced to use it in one job (in order not to get fired, I mean – of course, I still had a choice). I simply told the clients that it was just a description of what they’d told me and had no real meaning except that I needed to put it down for our agency to be paid for providing service. I told them that I selected the label that I believed would lead the insurance company to pay for the kind of service I felt they would benefit from based on our discussion. I was always clear that their own description of the situation and the perceived causes and possible solutions was what really mattered, not the diagnostic code. I am not sure that covered me, but I felt like it did with the client at least. Perhaps I should have staged a larger protest, but it felt like spitting in the ocean at the time (1995), as there was no real organized DSM resistance movement back then that I was aware of. I definitely felt like an outlier, if not a pariah, but I also felt my reframing was doing some good subversive education and advocacy with the client base.

    It is not by chance that I moved into advocacy after finishing that job.

    — Steve

    • The problem is that even if one tries to use DSM even in such supposedly miniscule way – the person still gets a label that will follow him/her till the end of their lives and potentially affect them negatively in all areas of life. Of course the worse the label the bigger the harm.

      • I disagree. My therapist and I mutually agreed on a diagnosis for me so he could bill my insurance provider. I put so little concern into the label, I actually can’t remember whether we decided on depression or adjustment disorder. In any rate, the label was useful for billing and I would do it again in a heartbeat. The label didn’t affect how my friends and family members treated me, nor did it come up in any subsequent job interviews.

      • Depending on the label, this is absolutely the case. For that reason, I avoided using “bipolar disorder,” any “psychotic disorder,” or “borderline personality disorder,” because those are the ones that are most likely to have long-term consequences. Have to be a little careful about “Major Depressive Disorder,” too. I tended to favor giving “Adjustment Disorder,” because by definition, it was temporary and therapy was the only intervention, or sometimes PTSD, of course with a strong recommendation of trauma-based individual therapy or groups rather than any psychiatric intervention. It was, however, quite an inadequate approach and I could not sometimes avoid those diagnoses, especially when people were unsafe and I could not let them leave the hospital and still keep my job. It was a pretty awful experience, though I have to say those that encountered me were very fortunate, because I’d do anything I could think of to prevent them from an involuntary hospitalization, including some pretty impressive ER therapy sessions! But it finally convinced me that by even participating in the system, I was colluding with the forces of evil. If I ever do therapy in the future, I’ll have to do it without insurance reimbursement, because I’d have to do what I thought was right even if the insurance company disagreed.

        Hence, advocacy.

        —- Steve