Debating Diagnosis and DSM-5 : Guest Post on Mental Health Chat

Guest Post on Mental Health Chat

Debating Diagnosis and DSM-5

 

The new ‘psychiatry bible’ DSM-5 has come under a lot of fire since it’s recent launch. One vociferous critic is Duke University’s Professor Allen Frances, himself a renowned psychiatrist who helped shape the (some say more valid) previous versions DSM-IV and DSM-IV-TR.

 

image of two volumes of DSM

DSM-5 and its predecessor DSM-IV-TR

Mental Health is a broad church and psychiatry only one faction within it, but it cannot be denied it is a major faction, with a very strong voice, perhaps the strongest to date. There are, nevertheless, many other voices – psychology, nursing, social work, therapists of various persuasions, neuroscientists, social scientists and most importantly, service users. There have, undoubtedly, been major advances in the understanding of mental suffering, mental health and well-being emerging from all of these camps, including psychiatry. The perhaps unexpected flak that has recently been directed at psychiatry as a body of knowledge has been generated by concern over what has been termed ‘hyper-inflated diagnosis’ and the seemingly relentless drive to medicalise every aspect of human life, including ‘normal’ sadness and grief (Frances 2013). Diagnosis is at the centre of the debate.

There is no doubt that people suffer. There is also no doubt that patterns can be identified in the forms that suffering may take. Furthermore, people often need a name for suffering, as a way of finding some understanding and therefore possible solutions. So diagnosis may well have a positive role to play in the future of mental health care and promotion, provided there are adequate and effective responses available. But does diagnosis really call forth effective treatments? Some would argue that the answer is No, not at all. The question “What does help?” will underpin my contributions here to the Mental Health Chat blog. Suggestions, points for discussion and leads to relevant studies will also be most welcome in the comments section. For now, here’s a link to the recent Maudsley debate [click on “48th Maudsley Debate: Diagnosis: Enabling or Labelling?”] on the issue of diagnosis. Those in favour [Prof Norman Sartorius and Prof Anthony David] talk about diagnoses as heuristic tools to guide research and practice, while those against [Dr Felicity Callard and Dr Pat Bracken] argue that diagnosis is a sticky label with little to offer therapeutically and too many social sequelae to be considered useful.

What do you think? What is your personal or professional experience? What are the alternatives?

Thanks for looking in, Roberta McDonnell

link and citation for DSM image: http://fr.wikipedia.org/wiki/DSM-5

Mental Health Chat 

is an online open access community with a weekly mental health twitter chat every Wednesday at 8:00 PM GMT / 3:00 PM ET / 12:00 PT. The hashtag for the twitter chat @MHchat is #MHchat  Mental Health Chat is dedicated to promoting and advancing the interdisciplinary understanding of mental health and mental illness.

Creative Mental Health: Scotland and UK

wordle of mental health and recovery terms

The Scottish Recovery Network recently called for a complete rethink on mental health care and in particular with regard to legislation. They have argued that,

To date, Scotland’s mental health laws have been recognised as progressively rights-based compared to many others around the world. However SRN believes this respected position is threatened unless we take the opportunity to engage in a much wider review of how our national laws reflect and respond to the changing legal and policy landscape.

Scotland is becoming an increasingly rights-based, recovery oriented nation….The law needs to better reflect and progress person-centred, strengths-based policy and practice that is already taking shape in Scotland and beyond.

Recovery seeks to achieve the best personal outcomes for all – people with lived experience and practitioners – and our laws can play a guiding role in achieving this.”  [SRN 2014]

 

Creativity and Mental Health

With the emphasis shifting away from illness and diagnosis and towards a focus on positive health, strength building and recovery of well-being, it is time to push for a complete overhaul of the whole idea of mental health  ‘treatment’ and ‘care’. A more refreshing picture would entail integrated services that recognise a central role for creative activity and social support in the lives of all humans, most especially when we are stressed, alienated, cognitively overwhelmed or in an otherwise vulnerable state. Those two factors emerge clearly from many qualitative and quantitative studies of service users’ perspectives and, furthermore, are even more effective when a dedicated place or site is available in which to gather on a regular basis.

It has, in fact, been demonstrated that given enough information, support and appropriate cultural conditions, people in the throes of extreme experience can and do navigate a course towards re-instating their well-being, indeed this could be thought of as creative recovery, a form of self-actualisation. No longer is it acceptable to write off people with severe mental health issues as ‘unsuitable’ for psychotherapeutic approaches. One UK study demonstrated that Cognitive Behaviour Therapy helped fifty percent of unmedicated participants to significantly reduce their psychotic experiences.

I recently reflected here on new developments in mental health in Ireland, much of which resonates with the work and approaches taken by the Scottish Recovery Network cited here, as well as with many commentators and activists in the UK such as Dr Joanna Moncrieff and in the US through informative and radical bloggers at Beyond Meds and Mad in America.

 

Rethinking Mental Health

An upcoming book by Professor Peter Kinderman at the University of Liverpool looks and sounds very exciting and resonates with my own current publication. Keep an eye out for A Prescription for Psychiatry coming soon.

 

citation for image and info: SRN, 15th April 2014, scottishrecovery.net @ Scottish Recovery Network and @SRN_Tweet

Creative Mental Health: Ireland

    Creative Mental Health Author Roberta McDonnell, information card for proposed network, Creative Mental Health Ireland.

Something of a paradigm shift is underway in the mental health field, as I discussed in a recent post  about new thinking in psychiatry. Though not a psychiatrist, I have many years of experience as a mental health nurse and health researcher, some of which were spent with people suffering in acute wards, at other times alongside those struggling to invoke recovery in a community setting. These experiences, along with many other studies, can be read about in my current publication Creativity and Social Support in Mental Health: Service Users’ Perspectives (Palgrave 2014). Without exception I observed honest, courageous people using many creative means to rebuild their lives and a strengthened sense of self, finding to my amazement and delight that many other researchers and service user activists were describing similar findings and experiences. It was, then, with further excitement, that I came across the work of Professor Ivor Browne in Dublin and beyond.

Professor Ivor Browne

In Music and Madness, we get a tremendous insight and an engaging story of how life experiences, in combination with with a very creative and fearless thinker, brought the somewhat maverick but highly effective psychiatrist to carry out the extensive work of support, reform and community development that he has accomplished in Ireland and beyond, a legacy which is still vibrant and still very much in the making. As a citizen-wide mode of mental health promotion, community development is essential and shifts our thinking away from a culture of individualised pathology and into a sense of the relational nature of humans – we make each other and we make ourselves, it’s a dynamic, two-way process. I am planning future posts that will be based on interviews with people involved in community arts, mental health promotion and recovery support. In the meantime,  enjoy Professor Browne’s work through his books and some interesting programmes from RTE on the history of mental health care and treatment.

 

image of book cover

Music and Madness by Professor Ivor Browne

Bedford Happy!

From her wonderful site here on WordPress, Marie-Louise Plum gives a great uplifting account of an arts for mental health project coming up in Bedford. Let’s hope this is the start of a new paradigm for mental health promotion and recovery. Look out too for my book with Palgrave Macmillan in April 2014, “Creativity and Social Support in Mental Health: Service Users’ Perspectives”, describing many more examples of the power of creative activity and social support in mental health and well-being. For now, join me in following up Marie-Louise’s fantastic leads here for more exciting work in this arena. Thanks Marie-Louise and All the best for now, Roberta 🙂

A mental health related arts project! In Bedford! Where I’m from! Ticking all the boxes here, press release below, read on folks…

Is Bedford the unhappiest place in Great Britain? The national press may think so, but Bedford Creative Arts think differently.

Bedford Happy is a project commissioned by Bedford Creative Arts. Kent artist Dan Thompson will be looking at the town, and working with local groups to find out where people are happiest – and what it is that gives them a happy buzz. A day-long artwork event will be produced celebrating Bedford’s happiness on Saturday 29th March. There will be a trail of interventions to make people a little bit happier, some special markers of happy memories and a celebration of the shops and cafes that are making people happy. “Bedford is an interesting place, full of quirky stories and interesting places, Bedford Happy is a great opportunity…

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