A Behavioral Approach to Mental Disorders

Today, after two years of deliberation, the Division of Clinical Psychology (which is part of the British Psychological Society) issued a Position Statement on the Classification of Behavior and Experience in Relation to Functional Psychiatric Diagnosis. It is subtitled “Time for a Paradigm Shift.” The DCP summarizes its paper as follows: "The DCP is of the view that it is timely and appropriate to affirm publicly that the current classification system as outlined in DSM and ICD, in respect of the functional psychiatric diagnoses, has significant conceptual and empirical limitations. Consequently, there is a need for a paradigm shift in relation to the experiences that these diagnoses refer to, towards a conceptual system not based on a ‘disease’ model." ...

BACKGROUND On May 3, 2013, David Kupfer MD (DSM-5 Task Force Chair) responded to Thomas Insel’s April 29th unequivocal attack on the validity and usefulness of DSM. You can see Dr. Kupfer’s response here. Essentially Dr. Insel said that the categories set out in the DSM did not correspond to anything in the real world, and that NIMH would no longer be using these categories as the basis for their research program. This statement did not, however, represent any significant movement away from the biomedical model on the part of NIMH. In fact, if anything, it was a movement towards an even more deeply entrenched medical model. But it was a huge hit on DSM and on the APA, who tout the catalog as the basis to their claim to scientific credibility. ...

There’s an interesting article on this topic by Hans Jensen et al, in the February 21, 2013 issue of the British Journal of Psychiatry. You can see an abstract here. The authors conducted a register study on all pregnant women in Denmark from 1996 to 2006, linking data from the Medical Birth Register, the Psychiatric Central Register, and the National Prescription Database. They found that the "… use of SSRIs during pregnancy increases the risk of a low Apgar score independently of maternal depression." ...

There’s an important article (here) on Monica Cassani’s website BeyondMeds in which she tackles the myth that once a person has been assigned a “diagnosis” of schizophrenia, he/she must take neuroleptics for life. Here’s a quote: "Unfortunately, at this juncture in history many people who get labeled with psychiatric illness these days do not have the opportunity for recovery because they are encouraged to stay ill by a system that all too often impedes psychological growth by use of excessive psychotropic drugs. This over-use of medication also kills people. The average life-span of people taking these medications is 25 years shorter than people who do not take these drugs. The drugs cause a long laundry list of problems only some of which are diabetes, obesity, heart conditions and a shrinking brain." ...

In the current issue of Clinical Psychology Review (April 8, 2013), you will find a very interesting article by Brett Jason Deacon, PhD, who is an Associate Professor of Psychology at the University of Wyoming. The article is called The Biomedical Model of Mental Disorder: A Critical Analysis of its Tenets, Consequences, and Effects on Psychotherapy Research. You can see it here. The article is a critique of the biomedical model from a theoretical and a practical perspective. The author has managed to elucidate a comprehensive range of criticisms of the biomedical model, and has blended them together into a coherent and compelling account. ...

I’ve just come across a strange article on Mad in America. It’s called Researchers look at therapeutic benefits of ketamine. You can see it here. It doesn’t identify an author, but it’s from the University of Manchester. The opening paragraph says: "The largest trial into the use of Electroconvulsive Therapy (ECT) in the UK in more than 30 years will look into how the use of the Class C drug ketamine might reduce the side effects of ECT for those being treated for severe depression." ...

There’s an interesting article in the May 2013 issue of the British Journal of Psychiatry. It’s called “The future of academic psychiatry may be social” by Stefan Priebe, Tom Burns, and Tom K. J. Craig. You can see it here. The abstract states: "The past 30 years have produced no discoveries leading to major changes in psychiatric practice. The rules regulating research and a dominant neurobiological paradigm may both have stifled creativity. Embracing a social paradigm could generate real progress and, simultaneously, make the profession more attractive." ...

BACKGROUND Sam Thompson (University of Liverpool) posted the following tweet on April 27: Can anyone point me to a good, succinct summary of the case for equating mental distress with illness? (serious, non-sarcastic question) On the face of it, this looks like a straightforward question, and one might think that a straightforward answer could be found. But this is not the case, because ultimately it boils down to a matter of definition. And psychiatry is a field where definitions are notoriously fuzzy. MENTAL DISORDER ...

BACKGROUND On April 29, Thomas Insel, Director of NIMH, published a paper called Transforming Diagnosis. You can see it here. Dr. Insel is critical of DSM: "While DSM has been described as a 'Bible' for the field, it is, at best, a dictionary, creating a set of labels and defining each." "The weakness is its lack of validity." This has created quite a stir, in that it appears to support the position of those of us who have been criticizing the DSM on these kinds of grounds for decades. It also suggests a fundamental rift between the NIMH and the APA, two groups who up till now had appeared to be joined at the hip. The article has generated a great deal of comment. So far, there’s been nothing from the APA. ...

I keep two dictionaries on my desk. The first is a 1964 Webster’s; the second is a 2009 Webster’s. This morning I looked up the word “depression” in both books. 1964: n. 1. a depressing or being depressed. 2. a depressed part or place; hollow or low place. 3. low spirits; dejection. 4. a decrease in force, activity, amount, etc. 5. a period marked by slackening of business activity, much unemployment, falling prices and wages, etc. ...