The Diagnostic and Statistical Manual of Mental Disorders (DSM), an authoritative classification tool in mental health care, has long been criticized for its neglect of social determinants and its rigid categorization of mental distress. As the field moves towards recovery-oriented, person-centered models, the DSM’s role is increasingly questioned.
In a recent article, Lars Veldmeijer of Utrecht University Medical Center and colleagues suggest reimagining the DSM as a “boundary object” and conversation piece to better serve the evolving needs of mental health care.
While some researchers argue to discard the manual entirely and seek alternatives, Veldmeijer and his team, including renowned psychiatrist Jim van Os and critical psychologist Sanne te Meerman, argue that discarding the DSM entirely would be detrimental due to its deep entrenchment in the mental health system. Instead, they advocate for using the DSM to facilitate a shared language between patients and professionals. Emphasizing participatory design, they call for the involvement of individuals with lived experience in co-creating spectra of distress, thus promoting a more inclusive and flexible framework. Their proposal aims to shift the power balance towards shared ownership and dialogue, marking a significant step towards a more person-centered approach in mental health care.
They write:
“Transforming psychiatric diagnoses by reconsidering and redesigning the DSM as a boundary object and conversation piece could be a step in the right direction. This would shift the power balance towards shared ownership in a participation era that fosters dialogue instead of diagnosis. We hope this hypothesis and theory paper can give decisive impulses to the much-needed debate on and development of psychiatric diagnoses and, in the end, contribute to lived experience-informed psychiatric epistemology. Furthermore, as a product of an equal co-production process between various disciplines and types of knowledge, this paper shows it is possible to harmonize perspectives on a controversial topic such as the DSM.”
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WRONG, Dr. Jim van Os, you’re wrong. SCRAP BOTH the DSM, AND the A.P.A.(“psychiatric”).
First, force the APA to cease admitting new members, so it dies a natural death, – literally.
Second, NO NEW DSM-6…. OK, a DSM-5R, or DSM-5-TR…..that’s fine….
The DSM is best seen as a catalog of billing codes. EVERYTHING in it is either invented or created, and NOTHING in it was discovered. Carefully consider the distinction….
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I haven’t read the article because it’s behind the paywall.
However, already this phrase makes me incredibly suspicious: “Their proposal aims to shift the power balance towards shared ownership and dialogue, marking a significant step towards a more person-centered approach in mental health care”
This power balance “technically” already exists in form of the various patient interest groups that, in reality, are largely funded and controlled by numerous industrial groups. E.g. CHADD is an non-profit “ADHD” patient group that receives nearly half of its funding from the pharmaceutical industry. These groups are known to present themselves as grassroots movements that only try to improve the lives of people “suffering from X,Y,Z”.
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Something is seriously wrong with a system in which we can talk about “”moving toward shared ownership and dialog.” What kind of help can be going on where shared ownership and dialog is not already THE central concept we are operating on? How can a therapist know what is helpful if they aren’t having shared dialog with their client????
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If mental illness is a myth (except for a relatively small number of cases where behavior and thinking have been demonstrated through rigorous testing and verifiable findings to originate in brain pathology or a neurological condition), any manifesto that seeks to divide it into separate, clearly defined categories, and any kind of therapy that attempts to treat it, are ipso facto scientifically invalid. Yes, the DSM is certainly entrenched in the mental health industry, but if this cult-like industry is little more than a set of more or less plausible hypotheses and outright fabrications, I see no reason why its “authoritative” bible should even be considered worthy of revision.
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BECAUSE, the DSM is IN FACT, a catalog of billing codes, and an instruction manual for the oppressors….you have to think “outside the box”, as the kids these days say….
The $$$ which perpetuates the fraud of psychiatry, and profits PhRMA, depend & rely on the DSM to advance the scheme….
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The only revision we can expect is psychiatry casting the net even wider to capture more behaviours and reactions as “pathological”. Because psychiatry and its claims operate as a belief system it cannot be penetrated by reason, logic or scientific evidence and as long as it fulfils a controlling function in societies through “Mental Health Acts”, no government will consider its abolishment or even attempt to curtail its power.
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This already happens with higher status patients. Good insurance good job good family…we can talk about it. And then…
There’s the psychiatric treatment I imagine most people…definitely those with severe diagnoses lower status people and those in hospital settings…receive. Take this. Take that. Be glad you’re here and not in the state hospital. On and on and on.
I agree with Szasz that psychiatry is slavery and treatment equals brain damage. I suppose that reforms could result in less severe brain damage and less restrictive slavery for some people in some places for a season…
Nothing short of abolishing psychiatry will accomplish very much to benefit more people families and society as a whole.
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The DSM is a book of deceits. According to Daniel Regier, psychiatrist and co-author of the DSM-5, diagnostic criteria “are intended to be scientific hypotheses, rather than inerrant Biblical Scripture” (Greenberg, G. 2013, The Book of Woe: The DSM and the Unmaking of Psychiatry, Scribe, New York, p. 125). Additionally, “there are no biological tests or brain scans that can be used to provide independent objective data in support of any psychiatric diagnosis” (Council For Evidence Based Psychiatry, 2024, http://www.cepuk.org). It is an abomination that psychiatry, an institute based on fiction, eugenics, torture, deprivation of liberty, and drug dealing, continues to exist when its methods are less valid than astrology, and it is responsible for the murder of half a million people every year (Gotzsche, P).
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test
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What are the benefits of involving individuals with lived experience in the development of mental health frameworks?
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They should not be “involved,” they should be the central architects of any such effort. Who knows better than those with “lived experience” what actually does and does not help???
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Indeed! I have a pathology affecting my temporal lobes esp. hippocampus function. It greatly impairs my memory function, and this fact, alone, should grab the attention of the theoretical and clinical communities in psychology. I am far from unique in its impact. However, psychologists want nothing to do with people like me because the DSM has declared us to be illegitimate. We are known as epileptics or untouchables. However, the DSM does include ‘psychosis in epilepsy’, so to get any psychological care, we first must kill somebody I suppose. Thanks, DSM!
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Your point is exceptionally important to people who have an “invisible” illness of any kind.
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