In January 2014, the journal Research on Social Work Practice ran a special issue called A Critical Appraisal of the DSM-5: Social Work Perspectives. There are fifteen articles on this general theme, and together they present a wide range of arguments against the DSM system.
Social workers represent the numerically biggest group of mental health practitioners in the US, and it is particularly gratifying to see a major social work journal addressing this topic so forthrightly.
In this post, I want to focus on one of the articles: A Critique of the Diagnostic Construct Schizophrenia, by Stephen Wong, PhD, BCBA-D, of the Florida International University in Miami.
Here are some quotes:
“Characterizing the many emotional, behavioral, functional, and social concerns listed in the manual as physical ‘diseases’ is a theoretical and ideological assertion. And even though this assertion is repeated endlessly in professional and commercial media, the claim rests on faulty definitions, logical fallacies, and weak empirical evidence (Boyle, 2002; Moncrieff, 2008; Read, Mosher, & Bentall, 2004; Valenstein, 1998)”
“Equipped with the knowledge of these and other therapeutic techniques, social workers can take a more active role in the design and implementation of effective psychosocial interventions, rather than being handmaidens of psychiatrists and relying on the finite benefits of their pharmacological treatments (Cohen, 1997; Harrow & Job, 2007; Hegarty, Baldessarini, Tohen, Watternaux & Oepen, 1994; Whitaker, 2010).”
“While current mental health services focus primarily on treating unconfirmed biological or neurological diseases (Gomory, Wong, Cohen, & Lacasse, 2011; Kingdon & Young, 2007; Whitaker, 2010), social workers and other mental health professionals should not confine themselves to this narrow, reductionist perspective and should be sensitive to other factors contributing to severe mental and behavioral disturbances.”
“There is abundant research on environmental and social adversity factors contributing to the development of schizophrenic symptoms and psychosis to guide our practice in social advocacy, prevention, and treatment of mental and behavioral disorders.”
“The biggest question is, given the many conceptual, scientific, and technical shortcomings of the diagnosis of schizophrenia, and of DSM diagnoses in general, why are social workers, psychologists, and other mental health professionals so dutiful in their use of the DSM and not more outspoken in their criticism of these psychiatric labels?”
“However, simply acquiescing to this medical ideology also has direct consequences for individual clinicians and their professions. For social workers, it means putting aside our person-in-the-environment approach, our appreciation of how life experiences and living conditions shape peoples’ thoughts and actions, and our professional independence.”
“Open criticism and resistance to the DSM would be a fitting starting point for organizing and opposing medical dominance and the biomedical hegemony over mental health services, and thereby better assisting members of our society with mental, emotional, and behavioral disturbances.”
I found Dr. Wong’s paper particularly encouraging not only for its intrinsic merit, but also for its rallying call to social workers to distance themselves from the DSM and from the concept of psychiatric illness generally.
I have often expressed the belief that a grassroots rebellion within the social work profession could be the tipping point in the marginalization of psychiatry, and in the development of an effective and truly person-centered framework for helping people in distress.