A Compelling Critique of Psychiatric ‘Diagnosis’

I have just read a very interesting and insightful article on this topic.  It’s called After DSM-5: A Critical Mental Health Research Agenda for the 21st Century.  It was written by Jeffrey Lacasse, PhD, and is a guest editorial published in Research on Social Work Practice.

Here are some quotes:

“At times, it has seemed that the APA has behaved very much like a corporation seeking profit and influence rather than a scientific organization charged with the crucially important task of defining mental disorders.”

[DSM-5]”… is vague and provides no clarity regarding the boundaries between what is normal and what is mentally disordered.”

“All problems defined in the DSM-5, from adjustment disorder to sexual problems to shyness, are just claimed to be medical…”

“The DSM-IV-TR mentions that brain changes in schizophrenia may be related to treatment with antipsychotic medication and notes that antidepressants may cause akathisia (a dangerous adverse effect associated with suicidal behavior…).   Despite the increasing body of literature demonstrating the clinical importance of these issues…references to both were deleted from DSM-5.”

“The DSM-5 field trial data demonstrate that DSM-5 categories are unreliable…a crucially important issue that should be addressed in both research and practice.”

“Thus the unreliability of psychiatric diagnosis can confound both the defining of client problems and the application of research evidence to clients.”

“…they sometimes explain that depression is caused by serotonin deficiency…  Clients are likely to absorb such messages as scientific facts…This should disturb those who think clinical practice and informed consent should be based on evidence, as serotonin deficiency as a cause of depression is known to be a myth…”

“Using the language of ‘mental disorder’ and presumed underlying brain disease or defect could have important effects on how clients view their problems and negatively impact their capacity to recover from them…”

Dr. Lacasse’s article is cogent and articulate, and cites a great many references.  It draws together succinctly, yet thoroughly, many of the critical issues in the present debate.

It has long been my position that psychiatry is scientifically empty and morally bankrupt.  It is time for the other helping professions to disassociate themselves from psychiatry and its spurious, money-driven “nosology,” and to develop their own person-centered conceptual framework for the services they provide.

It has also been my belief that social workers are ideally poised to provide a leadership role in developments of this sort.

Dr. Lacasse is by no means the first social worker to critique psychiatry, but his paper draws together many of the critical threads of this debate, and would serve as an excellent springboard from which the social work profession could re-appraise their ties to psychiatry.

Thanks to Mad in America for the link to Dr. Lacasse’s paper.

  • Pavonine99

    Have you read this?


    It’s a very clever summation of the DSM-5 system.

  • Sweet63

    The problem is, social workers typically are trained to be a cog in the whole psycho-social therapeutic machine. Their job seems to be to hook up clients with every welfare & nonprofit help program they can. They have to have justification like “mental illness” to qualify their clients for all the social services available, especially on a continuing (forever) basis. As you know a big part of that is SSD.

    In their eyes, it all works quite well, only we need more $$$ and shrinks etc. Always.

  • Phil_Hickey


    Yes. A work of art!

  • Phil_Hickey


    “…cog in the machine” is a good analogy, and it applies to all members of the mental health business who are not psychiatrists. Their job essentially is to feed clients into the psychiatric maw. Some have bought the illness model and see all
    this as wonderful. Others find it repulsive, and seek a way out. I think that as psychiatry’s inherent spuriousness and expansionist agenda become more and more obvious, the latter group is growing.