Academic journal article Journal of Psychology and Christianity

Systemic Critique of the DSM-5: A Medical Model for Human Problems and Suffering

Academic journal article Journal of Psychology and Christianity

Systemic Critique of the DSM-5: A Medical Model for Human Problems and Suffering

Article excerpt

The newest edition of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) continues to generate energetic debate among clinicians, researchers and academics regarding its overall utility and applicability to the clinical realm. While most critiques address the differences between DSM-IV and the DSM-5 from a clinical psychology perspective, our critique will be from the perspective of systemic thinkers and Marriage and Family Therapists (MFT).

There has been a tension in the MFT field with the DSM since its inception. Jay Haley and Salvador Minuchin, in Family Process journal over many years, ardently argued against the DSM. Both were passionately against the DSM because of its propensity to have an intrapsychic and individualistic emphasis. This newest edition of the DSM also creates tension for Christian clinicians, scholars and researchers who continue to wrestle with implications of personhood, pathology and healing.

Very Brief History of the DSM

DSM-I & -II were primarily created as a shared language that fostered research in mental health. These versions were individual-focused, although they also emphasized the individual affected by the environment. The DSM-III through the DSM5 5 taken a more descriptive approach where a patient meets a certain number of the criteria symptoms (e.g., 5 of 9 criteria met for the Major Depressive Episode diagnosis). Denton and Bell (2013) argued, "a DSM 'diagnosis' is merely a description of the client's self-reported problem and makes no implications regarding the 'causes' of that problem." (p. 153)

Concerns Regarding the DSM-5 Changes

We see the DSM-5 wanting to move to a medical model of diseases with causality based in biology and genetics, yet the diagnostic categories remain largely descriptive and only imply etiology. We acknowledge the need for a diagnostic manual; however, we are concerned that the DSM-5 is inadequate in accounting for the person, context and their relationships.

Systemic thinkers view people in a holistic way. People affect and are affected by their environments. Relational dynamics and systemic understanding view relationships being the heart of human personhood and suffering. We believe this current DSM is inadequate for clinicians working from a systemic perspective in the following ways. The principal changes in the DSM5 5 a) expansion of psychiatric diagnoses and easing of criteria, b) providing a medical/biological focus on etiology, c) removing the multiaxial system, and d) lacking any relational diagnostic criteria.

Expansion of Psychiatric Diagnoses and Loosening of their Criteria

MFTs have a tradition of seeing symptoms as a function of (or contributing to) distressed relationships. We agree with Allen Frances (2013), the primary editor on the DSM-IV edition, that normal human struggle, suffering and pain have become pathologized in the DSM-5- An example of this is the controversial removal by the DSM-5 task force of the "bereavement exclusion" for diagnosing Major Depressive Episode. Previously, people dealing with grief would not warrant a diagnosis of depression until the symptoms persisted for more than two months or there was severe impairment. Now in the DSM-5 there is no such exclusion, and many people experiencing a variation of normal grief in the short term would get a psychiatric label.

We believe that grief symptoms should not automatically lead to diagnosis of a grief disorder. Our broader concern is that the American Psychiatric Association's perspective of what qualifies as suffering continues to edge out historically and culturally accepted standards, and has put the mental health profession out of touch with people.

For systemic thinkers, existing symptoms that can be clustered together do not necessarily represent biological, causal explanations. We realize that context (e.g., culture, family dynamics, gender, resources), biology and their interactions mutually influence each other and create more of a trajectory for behavior, rather than representing a static cause. …

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