Rediscovering the Mind (Delaware Wave)

One of the ‘bibles’ of the mental health profession is the Diagnostic & Statistical Manual of the American Psychiatric Association (DSM). It is used extensively by psychotherapists and other mental health professionals in diagnosing mental disorders, syndromes and other problems. After much research, the current version, DSM-4-R is soon to be replaced by the DSM-5.

It will contain some enlightened changes. One is that the concept of “personality disorder” will be curbed or possibly discontinued. Apparently, many have come to believe that these labels excuse away personal responsibility by defining the individual only in terms of his or her arbitrary “disorder.” Regular visitors to this page know that I have always been bothered by that concept. I don’t like to tell clients, “You have such-and-such disorder.” I’d rather talk with them about their thinking, emotions and actions. Are there logical errors in their thinking? Are there patterns in their behaviors that lead to self-defeating outcomes? I find this more constructive than slapping a ‘disorder’ label on them. It’s not only unkind, but it also implies they have an illness and there’s nothing they can do about it, i.e., something external must change them. If that were true, there would be no point of psychotherapy and self-change. Pills or surgery would passively “cure” you.

That’s not only science fiction, it’s magical thinking.

Reportedly, there is also a statement in the new DSM to the effect that nothing in the manual is to be construed as having a legal definition in courts. Wow! For years, misguided courts and clever lawyers have been using psychiatric labels to excuse away (or perhaps demand government benefits for) all sorts of things. People could file suit under the Americans With Disabilities Act for being victims of mental disorders just the same as if they were physically handicapped. Mothers who drowned their children in a bathtub could rely on a legally sanctioned psychiatrist — who in turn relies on the DSM — to declare that she’s not a murderer, but a victim of a mental disease she could not help. Though the DSM is not a legal document, it is what courts and lawyers have been relying on to justify their “official” decisions and pronouncements. And now the new manual comes right out and states that it’s not valid for these purposes. Huge changes could be afoot.

Most interestingly, according to DSM-5 expert and suicidologist/psychotherapist Jack Klott, the trend in diagnostic procedures is shifting away from the medical/disease model and more towards a coping model. In other words, the new DSM will encourage mental health professionals to start looking at people’s emotions and behaviors as ways of coping with what they learned earlier in life, and to which they understandably still cling. As a cognitive therapist, my own way of putting it would be, “You developed certain false beliefs and behaviors which were understandable, even adaptive, given your past experiences. But now, in the present, they no longer apply. Our challenge is to help you replace them with thoughts that are healthier.”

It’s groundbreaking that diagnostic psychiatry — where the medical disease model has resided for many decades — is now shifting back towards the mind, i.e., emotions, defense mechanisms, false beliefs, and the like. By rediscovering the mind, psychiatry is rediscovering psychotherapy. As I said: Wow.

I’ve been writing for years about psychiatry’s errors in ignoring the mind and emotions in favor of brain chemistry and things that pills can supposedly ‘cure,’ but never do. If the most prominent psychiatric association is beginning to sing the same tune I’ve been promoting for years, then changes in that culture should be largely positive.

This could be good for a lot of reasons. Given that our country is, at least at the moment, moving away from limited government and more towards a welfare/entitlement state, people are going to need all the rationality and mental health they can possibly achieve. Who knows, maybe that will open the door to a future filled once again with a self-reliant, mentally healthy and self-assertive population.

Psychiatrists are now saying, in essence, “Hey, we’re not all brain chemistry. We have thoughts and feelings too.” My sentiments exactly.