Statement on DSM V

Position statement : MHE approach to DSM V

Mental Health Europe – along with others both within and outside mainstream psychiatry – has noted with concern the increasing dominance of a wholly biological approach to mental health problems.

One of the visible consequences is a relative downgrading of psychological and social interventions which support personal and social recovery. Moreover, psychological and social interventions are becoming more and more dependent on the biological model and less and less close to the needs and aspirations of people at a personal level when considered in their local context. This is in contrast with the social perspective of the UNCRPD. Mental Health Europe denounces the solely used method of bio-medical approaches.

The new version of the psychiatric Diagnostic and Statistical Manual (DSM V) in 2013 will expand the number of diagnosable conditions, for which medical treatment should be considered or which require further research before becoming “approved” by insurance companies for reimbursement of treatment costs. This can reinforce the growing marginalization of well-researched treatments, where medication is used short term, sparingly or not at all. Those who are alarmed by the expansion of the domain of medical psychiatry point to ever-rising prescription rates of drugs, accumulating evidence showing that the effectiveness of these drugs is scarcely proven, that they have significant and in some cases life-threatening side effects and that long-term consequences, both mental and physical are largely unknown¹.

Epistemological and ethical aspects also need to be considered. Science can be very useful for mental health and wellbeing but the simplistic and imposed application of partially explored, reductionist science can also impede understanding of the human condition and encroach on basic human rights.

¹In the past 10 years a number of well-researched books have set out evidence from independent studies, including systematic reviews, which point out the ways in which pharmaceutical companies manipulate research activity to promote their own products and deceive prescribing physicians. The recent heavy fines incurred by Glaxo Smith Klein for encouraging unlicensed use of its products with children are thought by many to represent the tip of the iceberg. English language publications which take this view and set out the evidence include: Robert Whitaker: Mad In America (2002); Richard Bentall: Doctoring the Mind: (2009); Robert Whitaker: Anatomy of an Epidemic (2010); Irving Kirsch: The Emperor’s New Drugs (2010); Ben Goldacre: Bad Pharma (2012). There is also a website called Mad In America (http://www.madinamerica.com) which publishes articles on related topics.

Next steps

Mental Health Europe as a membership organisation incorporates many different perspectives and points of view, but all members share a principled belief in the human rights of patients, especially the right to give or withhold consent to treatment, to be fully informed about the effects of treatment and to know as much as possible about the options and alternatives which are open to them. In furtherance of these principles MHE has established a Task Force to investigate, debate and report on the development of DSM V, its likely impact and on alternatives to wholly medical/biological psychiatry which are effective and which improve the lives and life chances of people with poor mental health.

In establishing this initiative we are aware that many groups within society share our concerns and we are therefore keen to make contact with them and for the ensuing debate to be as wide and open as possible.

BACKGROUND NOTE

The new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM V), which is the world’s most widely used psychiatric reference book, was released in May 2013.

The debate is particularly intense because the manual is both a medical guidebook and a cultural institution. It helps doctors make a diagnosis and provides insurance companies with diagnostic codes without which the insurers will not reimburse patients’ claims for treatment. The manual often organizes symptoms under evocative names. Labels like obsessive-compulsive disorder have connotations in the wider culture and for an individual’s self-perception. The current edition of the manual, which was published in 2000, describes 283 disorders – about triple the number in the first edition, published in 1952 – probably it will be further expanded. Experts say that some of the most crucial debates are likely to include diagnoses of illness involving children and addictions like shopping and eating. Psychological and sociological contributions are accepted only if in line with the basic criteria of DSM which are becoming more and more biologically oriented. It should be remembered how the 3rd edition of DSM in 1980 was changed by dropping out previous psychoanalytical contributions and by orientating towards a more medical perspective. The medical approach to human problems runs the risk of being over-implemented leaving behind other kinds of approaches.