The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been a thorn in the side of professionals who are interested in treating people with dignity and autonomy, and a scourge on consumers of psychiatric and psychological services, whom it stereotypes with biological and characterological defects. Despite its well-known political and discriminatory foundations, it has ruled the landscape of psychiatric ministrations and research. This situation is particularly troublesome given the failure of its apologists to establish its scientific validity, and the recent complaints about the latest edition’s overly broad and inclusive reach, effectively anointing almost any human problem as “mental illness.”
Psychotherapy and the problems it targets are fundamentally interpersonal, intrapersonal, and existential issues. They aren’t really about literal health and illness. Nonetheless, insurance companies have chosen to consider psychotherapy a “medically necessary” service. Therefore, people who otherwise could not afford those services out of pocket have resorted to their insurance benefits in order to seek out help.
But the problem with this is that in order for insurance to pay, they have to be diagnosed with an invalid DSM diagnosis. Using an invalid diagnostic tool flies in the face of professional ethical guidelines. Of further insult above and beyond the question of validity, DSM diagnoses can also cause substantial harm, especially for young people. Employment opportunities, security clearances, and insurance eligibility can be jeopardized by having such a diagnosis in one’s health record. Moreover, these diagnoses create the impression of personal defect, which can seriously compromise one’s sense of self-worth, hope for the future, and others’ perceptions of the person so diagnosed, leading to social isolation and mistreatment. And keep in mind, this is all due to a label for an invalid construct.
This places professionals in an ethical double bind. In order to work with people who choose to use health insurance benefits, the professional must provide a DSM diagnosis; a diagnosis known to be invalid and potentially harmful. If, on the other hand, the professional refuses to diagnose in order to avoid the harm, and precluding insurance coverage, then the consumer may not be able to afford badly desired help.
In recognition of this ethical dilemma, ISEPP has drafted an open letter to four principal professional organizations in the United States, publicizing this concern and asking for ethical guidance. The draft of this letter is included below. ISEPP is soliciting other groups to join us in this letter. If your group is interested, and if you know of any other principal professional world-wide organizations that should receive this letter, please contact me at [email protected] or Matt Stevenson at [email protected]. We hope to have the letter sent by March 1st.