{"id":226,"date":"2013-05-24T16:32:00","date_gmt":"2013-05-24T15:32:00","guid":{"rendered":"https:\/\/blogs.canterbury.ac.uk\/discursive\/2013\/05\/24\/the-dsm-dust-up-whingeing-cranks-turf-wars-and-epistemological-disputes\/"},"modified":"2015-11-11T13:22:09","modified_gmt":"2015-11-11T13:22:09","slug":"the-dsm-dust-up-whingeing-cranks-turf-wars-and-epistemological-disputes","status":"publish","type":"post","link":"https:\/\/blogs.canterbury.ac.uk\/discursive\/the-dsm-dust-up-whingeing-cranks-turf-wars-and-epistemological-disputes\/","title":{"rendered":"The DSM dust-up: Whingeing cranks, turf wars and epistemological disputes"},"content":{"rendered":"

On Sunday \u00a0the12th of May, The UK Observer<\/i> ran a front-page article<\/a> stating that the Division of Clinical Psychology (DCP), a subdivision of the British Psychological Society (BPS), was releasing a position statement<\/a> calling for a \u2018paradigm shift\u2019 in mental health. The proposed shift was away from a view of mental health problems as illnesses with biological roots, and towards greater consideration of \u00a0psychological and social factors.<\/p>\n

The DCP did its best to get the media interested and was rewarded with extensive coverage. The Observer and Guardian website included an online poll<\/a>and other articles<\/a>and commentaries<\/a> that explored the debate in some depth.\u00a0 The Daily Mail ran a piece<\/a> the following day.\u00a0 Lucy Johnstone and Richard Bentall, both Clinical Psychologists and critics of the \u2018disease model\u2019 of psychological distress, appeared on Radio 4 and Peter Kinderman, a former DCP Chair, was on telly in Canada.<\/p>\n

The release of the statement was a significant move in the world of mental health.\u00a0 The DCP was making an uncharacteristically vocal stand against the medicalisation of distress. The timing was also interesting being just before the publication of the DSM-5, the 5th<\/sup> (and most extensive<\/a>) edition of the controversial manual for mental health diagnoses.\u00a0 Naturally, this ruffled a few feathers, but even those who disagreed with DCP\u2019s stance could appreciate the value of bringing the debate into the public domain?\u00a0 And surely the public would get on board with such an important issue?<\/p>\n

Well, sort of.\u00a0 While there was some intelligent, thoughtful discussion, comments from the public on the Guardian website ranged from positive to indifferent through to vitriolic. Comments on a website aren\u2019t necessarily the greatest measure of public attitudes, but they nevertheless made for thought-provoking reading. <\/span>\u00a0Two emerged as of particular interest.\u00a0 The first was the idea the psychologists are basically charlatans. Here are a couple of comments from an, alas, far wider pool:<\/p>\n

\u2018\u2026this psychology thing is pure quackery. Psychiatry at least kept the symptoms in control whereas a faith healer like a psygologist [sic] would not have been able to do anything.\u2019
\n(Source: http:\/\/discussion.guardian.co.uk\/comment-permalink\/23478041<\/a>)<\/p>\n

\u2018I have never trusted so-called psychological therapists. Any crank can set themself [sic] up as a therapist and fleece the worried-well of their money. Even those with some qualifications in psychology have no real insight into mental illness\u2026If you have chest pains you see a cardiologist. If you suffer from clinical depression you need a psychiatrist.\u2019
\n(Source: http:\/\/discussion.guardian.co.uk\/comment-permalink\/23494276<\/a>)<\/p><\/blockquote>\n

As a trainee clinical psychologist, such remarks made uncomfortable reading and are perhaps indicative of a PR failure on the part of psychology. Psychologists place great emphasis on the role of the \u2018scientist-practitioner\u2019, someone whose work is informed by research and who contributes to the evidence base by carrying out their own research in the field.<\/p>\n

However, even if you accept that psychologists are not quacks, there is still the issue of professional vested interests. Some comments suggested that this might underlie the DCP stance:<\/p>\n

\u2018[Medicalising mental health is] good business for psychologists and psychiatrists so all they’re arguing about is who should get the booty.\u2019
\n(Source: http:\/\/discussion.guardian.co.uk\/comment-permalink\/23468473<\/a>)<\/p>\n

\u2018This sounds like turf wars to me – the psychologists want to claim all mental disorders for themselves.\u2019
\n(Source: http:\/\/discussion.guardian.co.uk\/comment-permalink\/23484406<\/a>)<\/p><\/blockquote>\n

While it\u2019s worrying that the debate has been framed as \u2018psychology versus psychiatry’, there are some obvious reasons why it may be perceived in that way.\u00a0 The Observer headlined their front-page article as \u2018Psychiatrists Under Fire in Mental Health Battle\u2019 and debates in the news have invariably featured a psychologist and a psychiatrist in conflict.\u00a0 It\u2019s a neat narrative, but an inaccurate one.<\/p>\n

In her Radio 4 interview on on 13 May, Lucy Johnstone opened by saying \u2018This really isn\u2019t an argument between psychologists and psychiatrists\u2019.\u00a0The Critical Psychiatry network has issued a statement<\/a> explicitly rejecting the idea of a \u2018guild dispute\u2019. While psychologists and psychiatrists sometimes have different views, most psychiatrists I\u2019ve encountered recognise the importance of social and psychological influences. Likewise most psychologists acknowledge biological factors. Placing the two professions in direct conflict stimulates defensiveness, dismissiveness and a closing of ranks which could be detrimental to our understanding of what is arguably the most significant issue in mental health.<\/p>\n

The real debate is about how we view people who experience distress.\u00a0The biomedical approach implies that we should view people first and foremost as clusters of symptoms and locates the problem (primarily) within the brain.\u00a0The biopsychosocial model favoured by the DCP argues that this only tells part of the story.\u00a0It is a plea to view the person in the context of their lives, relationships and experiences as well as <\/i>their biology. This is an important debate with implications that reach well beyond than professional one-upmanship.\u00a0 It\u2019s about whether a diagnosis such as \u2018schizophrenia\u2019 is either necessary of sufficient to understand someone.\u00a0 It calls us to think about whether current mental health services are up to the task and invites us to think about viable alternatives.\u00a0At its broadest, it asks us whether placing the causes of madness inside an individual distracts attention from the interpersonal, social, cultural, economic or political factors that influence all of us.\u00a0Engaging the public in an open discussion about models of mental health is overdue.\u00a0It just seems that this discussion hasn\u2019t quite got off the ground.<\/p>\n

By Leigh Emery<\/a><\/i><\/div>\n","protected":false},"excerpt":{"rendered":"

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