Peter Kinderman, PhD, published a very interesting post on May 15. It’s called So…What Happens Next? You can see it here. Dr. Kinderman is a former chairperson of the BPS’s Division of Clinical Psychology. That’s the same DCP that recently criticized psychiatric diagnoses and called for a paradigm shift. Here are some quotes from the post.
“Psychiatric diagnoses fail to map onto any entity discernable in the real world, fail to predict the course of a person’s problems and fail to indicate which treatment options are beneficial.”
“Diagnoses convey the idea that people’s difficulties can be understood in the same way as bodily diseases, and are used as pseudo-explanations for troubling behaviours.”
“And, as if to drive the worries home, as the debate over DSM-5 gathered pace, we learned not only that 70% of the task force responsible for revising DSM-5 had financial links to pharmaceutical industry, entirely unsurprisingly – but also that physicians had already developed specific pharmaceutical products designed to ‘treat’ grief.”
“All decent mental health professionals will guide their care of their clients on the basis of more than a diagnosis (one of the other reasons why they are fundamentally flawed), and so the idea that we should come up with a case formulation – a set of working hypotheses about what might link the person’s problems, what might have caused them, and what might help – is not radical.”
As an alternative to DSM-type diagnoses, Dr. Kinderman suggests a problem list, together with a psychosocial formulation.
What this means essentially is: help the client state the presenting problem(s) in clear, simple language; help to tease out how these problems might have developed and what factors might be sustaining them; and, of course, look for and encourage remedial action.
A fundamental assumption underlying this approach is that human problems are inherently understandable when viewed from the client’s perspective, and that each person can, with help if necessary, find his/her way to a more fulfilling and more successful lifestyle.
This is a far cry from psychiatric “diagnosis,” the essential message of which is: you are inherently flawed; you are incapable of tackling your problems; you have an illness which I understand; you must take the drugs that I prescribe for you.
Dr. Kinderman’s post is a critical follow-up to the earlier DCP statement. Hopefully it will provide encouragement to psychologists, social workers, counselors, case managers, etc., to transcend the limitations of the DSM categories, and to develop a truly individualized and client-centered approach. Many mental health workers, of course, are already doing this, but at the same time are constrained by the medical model to refer clients for drugs and to promote the necessity of taking the drugs. Within a psychosocial model, the clients’ real needs would take precedence.