Biomedical and DSM

 9/11/2022

    Each article exposed key issues with the DSM and mental health diagnoses that create long-term problems. These problems create a chain reaction- the DSM's struggle to define disorders or include/exclude certain disorders leads to problems with therapy approaches, which then leads to harmful or unhelpful treatment. In a way, our field has tried to simplify disorders to make the job of a clinician easier, but, in turn, it created a larger mess that needs a radical change. Psychology cannot be reduced to biology or another specific area. People are complicated and there is no one answer to mental health diagnoses. 

    The DSM holds a vast group of disorders that then has huge variability within individual criteria. The umpire analogy helped to understand different approaches to mental disorders. Specifically, the 3rd umpire showed the dangers a diagnosis can have. A certain label can kick people off of insurance, institutionalize them unwillingly, incarcerate them because of a threat they possess, and possibly put them on medication. As discussed in the Biomedical Model, psychotropic medications actually have little foundation in addressing the real issues of disorders. They have been promoted by major drug companies, the FDA, and the APA but have little science to back them up. Psychologists have followed the lead of these major corporations to promote medical treatment, and few people have looked at the real science. This was shocking to me. How are we as clinicians supposed to properly help people if the literature and the APA are not telling the whole truth? It is important to apply critical thinking skills to all situations, but psychotropic medication is a difficult topic to uncover. There have been plenty of cases where they seem to work and help people with certain disorders, so why does science not support it? Maybe we are measuring the wrong thing and looking at the wrong parts of the brain? As a future clinician, should I encourage the use of medication if I know the science isn't there, but have testimonies of times it was helpful? Is that ethical? There are not a lot of people pushing back on using medication because it is a huge money maker. A revealing experiment would be to include caffeine dependency in the DSM to see how quickly new medications arise to "treat" it and how quickly people are diagnosed even though it is not a major issue for most people. 

    Before I could even consider medication, however, I would have to figure out a diagnosis. As seen in these articles, there are plenty of problems with the DSM. I had not considered that the DSM is not inclusive of all perspectives of psychology. It describes symptoms that are behaviors, not cognitions, or past experiences as they are much more difficult to assess. At the same time, it assumes that these behaviors are symptoms of mental illness whereas some may see disorders as problems with behavior. I also wondered if parts of the DSM are measuring normal, human nature things, and making it a disorder. If 50% of the population qualifies for anxiety disorders then is it really a disorder? Of course, there are people who cannot function and have extreme cases of anxiety, but for others, it could be more attributed to personality or skill. For example, people in police departments, FBI, or CIA should be constantly thinking of what could go wrong, be hyper-aware of their surroundings, and feel high levels of stress because that is their job. Does that mean that they have an anxiety disorder or are they good at their job? One article mentioned that diagnoses are sometimes more founded on consensus than data. How would I go about this differently as a clinician? 

With all of this in mind, it is important to take everything with a grain of salt. Nothing is simple, money will always control our society, and our field needs skeptical clinicians with a focus on the patient.