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To oppose the DSM-5 is not to oppose psychiatry
Recently, some of the DSM-5 supporters have been trying to portray the opposition against the fifth edition of this manual of the American Psychiatric Association as an opposition to psychiatry and a form of antipsychiatry. This political argument aims to discredit the movement and to subsume it in its entirety, including its numerous variations, under a single label, one that can easily be identified and connected with a certain history, the sixties. Such specious rhetoric allows its authors not to have to respond to serious and well-documented arguments of the DSM-5 critics. In reality, its many opponents from Europe, Australia, South America and even the United States include a great number of psychiatrists, clinical psychologists, social workers and other mental health practitioners. These persons are deeply invested in psychiatry, they categorically refuse the idea that a mental disease is only a myth and they reject not only scientism and its bio-mythology but also obscurantism; they belong to very different schools of thought and draw on philosophical, scientific, clinical and ethical theories and forms of knowledge with a long intellectual tradition. They are deeply concerned with the rights of the users of psychiatry in their daily care. They are committed to the struggle against all forms of discriminations from which these users continue to suffer and to their real participation in the decisions that concern them, without denying the reality of mental illness and without automatically reducing any users of psychiatry to victims.
Many of those who oppose the DSM-5 do not reject the idea of a classification of mental diseases in itself but consider it essential for the purposes epidemiology, research and clinical work; however, they contest the reliability, validity and usefulness of the DSM-5. Likewise, many of them do not refuse the idea of a psychiatric diagnosis as such, on the condition that it is not fixed, decontextualized or reifying as it is in DSM, and they are willing to look for and develop realistic alternatives which avoid stigmatization, while providing both practitioners and patients with useful points of reference. The critics of the DSM-5 to whom we belong, without getting into an etiological quarrel ,question the exclusivity of the biomedical model, which leads to a reductionism of psychic suffering by equating it to the effects of a brain lesion; yet they do not refuse the idea of a biological cause which may contribute to some mental diseases. They refuse to watch psychiatry being split, without any scientific reason, into, on the one hand, a pseudo-neurology, and, on the other hand, social service. They are in favor of real scientific breakthroughs, but they refuse a scientifical ideology far from the clinical realities. They do not a priori reject pharmaceutical prescriptions when they turn out to be essential or simply useful and when they can help bring about a patient’s remission or even recovery.
Having it out once and for all with the DSM
Mental health should no longer refer to a single textbook required by the WHO.
The nomenclature of the DSM, on which WHO’s ICD-10 has been modeled, has progressively become the single and obligatory classificatory reference of "mental disorders":
- in epidemiology;
- in the field of research and scientific publications;
- for social protection systems and insurances;
- in order to collect statistical data for care policy and financing;
- as an unique reference manual in the teaching of psychiatry in medical and psychology schools, for the training of professionals and lecturers in health, social and special education fields;
- finally, for physicians, who, having no other relevant training, prescribe more and more psychotropic drugs, based on questionable diagnostic criteria.
HAVING IT OUT ONCE AND FOR ALL WITH THE DSM
The Mandatory Diagnostic Reference to the DSM is contrary to scientific initiative; Harmful to treatments of the human psyche; Costly for governments; Paralyzing for research and teaching.
The term “psychical or mental suffering” cannot be confined to the traditional definition of “illnesses,” because it may impact anyone and everyone. The World Health Organization has deemed it a major priority, but then initially engaged itself in the struggle against it via a one-sided choice which views the Manual issued by the APA (American Psychiatric Association) as grounded in science. WHO’s restrictive choice bears the generic name of “DSM,” or Diagnostic and Statistical Manual of Mental Disorders, the third version of which stigmatizes conflicts that are important to psychiatric evaluation, and is contemporaneous with the treatment recommendations of the behavioralists and practitioners of CBT. Since its methods are not clearly delineated, they are also contributing to the promotion of an indispensable pharmacological accompaniment.