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.

 

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: Ireland

    Creative Mental Health 

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.

 

Music and Madness by Professor Ivor Browne

Professor Dinesh Bhugra on refreshing psychiatry

Psychiatry’s New Era

With admirable clarity and much insight on cultural and social factors in mental health and wellbeing, Professor Dinesh Bhugra is due to take up the Presidency of the World Psychiatric Association.

Symptoms are not the essential focus, rather ‘social functioning’ is key, argues Professor Dinesh in a recent Guardian feature interview by Patrick Strudwick. Click the link to read the full article in the Guardian

and for Professor Bughra’s site,

Professor Dinesh Bhugra.

 

Psychiatry needs Social Anthropology and Sociology

With a polymathic background in not only medicine but in sociology and social anthropology as well, Professor Dinesh heralds in a much needed new era in approaches to mental health across the globe. Not only do patients and citizens need this, psychiatrists and allied professions do too – according to Professor Bughra, morale is at an all time low and much needed services such as day centres and rehabilitation models are currently under erosion.

I am in total agreement with this new approach and hope it will materialise in not only improved services, but services that take account of service users’ views and those of many people who have incorporated what might be termed ‘psychiatric symptoms’ into a creative way of being human – as well as finding ways to improve and boost their own mental health and wellbeing with positive psychology, creative and meaningful activities and various forms of social support. One very uplifting and encouraging story is told by Eleanor Longden, who discovered that many people are voice hearers and that the voices are often attempts to heal, emerging from the inner world (as R. D. Laing and Carl Jung also intuited in days gone by).

While some might argue that psychiatry should drop the  diagnostic ‘labelling’ altogether and that medication should have no place in mental health support, others see the changes required as a more expanded repertoire within the mental health professions,  to include mindfulness, meditation, diet, various healthful activities and especially some form of regular, meaningful occupation. For more detail on these themes see a recent post on Ruby Wax’s book, Sane New World and some recent scholarly work by Joanna Moncrieff, The Bitterest Pills and Rapley et al De-Medicalising Misery.  My own book based on service user perspectives is due out in April 2014, Creativity and Social Support in Mental Health.

I wish you all good mental health and welcome comments, views and suggestions for helpful sites and other media.

Psychiatry tag cloud Image citation and source: http://commons.wikimedia.org/wiki/File:Psychiatry_tag_cloud.svg

The Inspirational Ruby Wax

SANE NEW WORLD is a wonderful book by Ruby Wax, a gift to us all. In a previous article by Ms Wax in The Guardian  she openly describes her experiences and insights into mental health difficulties and recoveries, specifically with depressive episodes. Here she is in her inimitable gripping, ironic prose, ‘depression isn’t about having a bad hair day. In actuality it feels like your old personality has left town and you’ve been replaced by a block of cement; indifferent if you win the lottery or fall off a cliff.’ Ms Wax goes on to reflect that shame sets in alongside well-meaning but ill-informed advice to ‘perk up’, that is until you discover fellow sufferers with whom you identify and both give and get empathy – social support in action. But that support should be more widely available and built into society, she argues, in the form of walk-in centres and the regular availability of places to meet and mentor on the AA model. Her vision resonates well with the central thesis of my upcoming book entitled Creativity and Social Support in Mental Health: Service Users’ Perspectives (Palgrave). My main findings with day centre clients were the importance of having  somewhere to go and something to do every day, as well as routine and reliable social support. There is such a lot going on, awareness is growing, stigma is dissolving (slowly, we must keep at it). This blog will join the groundswell and hopefully contribute useful ideas and observations or at least help to bring voices together. Please feel free to add comments and suggestions. Thanks for looking in and until next time, look after your mental health 🙂