Tag Archives: social work

The Dehumanizing Aspect of DSM

In January 2014, the journal Research on Social Work Practice published a special issue: A Critical Appraisal of the DSM-5: Social Work Perspectives.  There were many excellent articles in this volume, some of which I have highlighted in earlier posts.

One of the very outstanding articles is The Diagnostic and Statistical Manual of Mental Disorders as a Major Form of Dehumanization in the Modern World, by Eileen Gambrill, PhD, a graduate school Professor at the School of Social Welfare, University of California, Berkeley.

Here’s the abstract:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is one of the most successful technologies in modern times. In spite of well-argued critiques, the DSM and the idea of ‘mental illness’ on which it is based flourish, with ever more (mis)behaviors labeled as brain diseases. Problems in living and related distress are converted into  medical problems, obscuring the role of environmental factors such as poverty and related political, social, moral, and economic factors such as the interest of the state in controlling deviant behavior and maintaining the status quo. This view shrinks rather than expands opportunities for freedom, growth, and dignity. It ignores the vast literature showing that unusual environments create unusual behaviors and that by arranging learning opportunities we can change behavior. Reasons for this marketing success are discussed and alternatives suggested including consensual counseling regarding problems in living and drawing on a science of behavior attending to environmental learning opportunities.”

This article presents a fundamental and thorough challenge to the idea of mental illness, with its dehumanizing consequences, and its decontextualized approach to human problems.

The article is lengthy – 19 pages plus references – and it is impossible for me to convey the depth and impact of the piece in a short post of this kind.  Here are some quotes:

“Psychiatric labels have been applied to an ever-increasing variety of behaviors viewed as mental disorders.”

“Biomedical psychiatry and pharmaceutical companies, with the help of the state, have been very successful in forwarding medical views of problems-in-living including transforming everyday behaviors, thoughts, and feelings into mental illnesses requiring medical solutions (medication), as illustrated by the ever-lengthening list of behaviors viewed as signs of mental illness and promotion of medical remedies (prescribed medication).”

“Acceptance of the statistically normal condition as equivalent to the psychologically healthy one results in pathologizing people who vary from the statistical norm and even imposing intervention on such individuals.”

“A DSM label gives an illusion of understanding, encouraging detachment from lived experiences.”

“Central to the understanding of words and their effects is reification: the assumption that use of a word means that the reality to which the word allegedly refers actually exists.”

“The promotion of the belief that deviant or troubling behaviors are caused by an illness (a brain disease) has spawned scores of industries and thousands of  agencies, hundreds of research centers, and thousands of advocacy groups that forward this view, none more successful than the industry of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association.”

“Being labeled may result in attention only to characteristics that complement the label – a confirmation bias.”

“An individual functional analysis will typically reveal that behaviors, even those that appear bizarre and irrational ‘make sense.’   That is, there is a payoff for the client but at a high cost.”

“Stripping life’s trials and tribulations from their context is dehumanizing in understanding related experiences and potential remedies.”

“With the publication of the DSM 5, there is yet another opportunity for social work to think carefully about its role in promoting and being a handmaiden to a medicalized view of troubling, troubled, and very dependent behaviors. Social work has an inspiring history of attention to avoidable suffering and injustice—not just talking about it, but actively trying to reduce it.”

“The DSM shrinks rather than expands opportunities for freedom, growth, and dignity by obscuring the vast literature, which shows that behavior is influenced by the environment. If we accept the grand narrative of disease to understand behavior, we become architects of clients’ dehumanization as well as our own. By recognizing environmental circumstances, we can understand that behavior always makes sense.”

“A number of trends encourage use of a contextualized approach to understanding human behavior and avoidable suffering. One is the sheer excess of medicalization including deception and fraud on the part of the pharmaceutical companies and physicians and scientists…”

“It is time to wake up from our slumber in the arms of a medicalized psychiatry to recognize missed opportunities to help clients.”

Dr. Gambrill’s article embraces almost every facet of the current psychiatry debate.  Her arguments are cogent and clear, and her references are comprehensive.  The article is scholarly without being tedious.

Dr. Gambrill’s call to Social Workers, both in academia and in the field, to emancipate themselves from psychiatric dominance, and to focus more on alleviating distress by mitigating its true causes, will hopefully resonate widely.

I strongly encourage my readers to read this article and pass it on.