Response to the American Psychiatric Association by the BPS

Chamade

Just wondering if any mental health professionals on this forum had seen the BPS reply to the development of the DSM 5 and what are your thoughts on this.
I have added an attachment you can read or go to the link below (sorry I am sure there is a better way to provide a link but I don't know it!)



http://apps.bps.org.uk/_publicationfiles/consultation-responses/DSM-5%202011%20-%20BPS%20response.pdf

Naikon

The DSM is mostly a work of fabrication.

hotspur

That's a surprisingly ignorant and unhelpful response from the BPS. Anyone who judges the DSM by criteria of physical disease at this stage clearly just doesn't understand the socially constructed emergent functions of it and the contexts in which it is utilised.

The BPS response smacks of interprofessional gibing tbh.

Naikon

More importantly, will the BPS petition to the APA to bring back Homosexuality as a mental disorder?

JuliusCaesar

Naikon wrote: »

The DSM is mostly a work of fabrication.

Naikon wrote: »

More importantly, will the BPS petition to the APA to bring back Homosexuality as a mental disorder?

you obviously didn't read the document. You already have aquired a few warnings and this is the last one. Informed contributions only or you are gone. JC

Chamade

hotspur wrote: »

. Anyone who judges the DSM by criteria of physical disease at this stage clearly just doesn't understand the socially constructed emergent functions of it and the contexts in which it is utilised.



I don't understand your comment above, Surely it is the BPS that is saying it is not helpful to view problems as physical diseases.

"We believe that classifying these problems as ‘illnesses’ misses the relational
context of problems and the undeniable social causation of many such problems.
For psychologists, our well-being and mental health stem from our frameworks of
understanding of the world, frameworks which are themselves the product of the
experiences and learning through our lives. " (BPS Letter)

and....

"As stated in our general comments, we are concerned that clients and the general
public are negatively affected by the continued and continuous medicalisation of their
natural and normal responses to their experiences; responses which undoubtedly
have distressing consequences which demand helping responses, but which do not
reflect illnesses so much as normal individual variation." (BPS letter).

hotspur

The BPS are railing against the idea that the DSM is a manual of psychological problems which stem from biological causation. They state that clearly such problems are based on social norms and subjective judgements about symptoms.

Of course most of the DSM disorders have elements of social construction and subjective judgement. I can't imagine many people, psychiatrists or otherwise, would disagree with that. So attacking the proposed new DSM on the basis that the disorders don't have a clear underlying biological causation is to misunderstand the reality of the manual.

The APA might officially say that these are disorders with a biological basis (and they are right insofar as every aspect of us has a partly biological basis) but ultimately the DSM is a collection of symptoms that people present with to psychiatrists irrespective of their origin. Then the task is to somehow make sense of these symptoms in larger units of regularly clustered symptoms and to label these clusters in a taxonomy.

I believe there are multiple benefits to this.

But the BPS did complain many times in their document that these symptom clusters and their nomenclature are unhelpful because they are not up to the standards of medical diagnosis:

"Diagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses."

They are beating the APA up for using a concept of illness for what they term normal individual reactions. The reality is that if someone ends up presenting in front of a psychiatrist they need to be "ill" or they are not going to get treatment, be it paid for by the state or by a health insurance company. The insurance aspect is the real reason why there are diagnoses which cover everything possible in America. A DSM code simply has to be entered into the insurance form or treatment will not be paid for and therefore not provided.

I am saying that in reality the DSM and its use is so much more than a manual which categorises biologically based illnesses. And to beat the APA up because the DSM falls short of the standard of medical taxonomies is to misunderstand and underappreciate the totality of what the DSM is and how it functions.

The BPS paper essentially is a document attacking the professional domain of psychiatrists, and it is attacking it in the same manner as droolers from scientology or disgruntled former clients that it is invalid because it has not established the biological basis for the disorders as well as other medical nosologies.

Naikon

JuliusCaesar wrote: »

you obviously didn't read the document. You already have aquired a few warnings and this is the last one. Informed contributions only or you are gone. JC

I deserve another ban at this stage. I will stop with this ****e from now on. Psychology is a Science, this I cannot dispute.

Chamade

Hotspur you said in your earlier post that the BPS didn't understand the context in which the DSM exist but it does not just exist to inform Insurance companies, it is also used in the context of mental health and to inform around issues, whether you are a client or practitioner etc.
Insurance companies are informed re mental health via the DSM so if changes were made to it's structure then why would that make a difference to them, as where did they get their information in the first place.

If a client arrived with let's say 4 of the criteria for depression instead of the required 5, and the therapist could see quite clearly that this person was really struggling, does that make their depression less real.
It works both ways.

I found your reference to Scientology unhelpful as the authors of the BPS letter are well informed and respected Psychologists.

metrovelvet

hotspur wrote: »

The BPS are railing against the idea that the DSM is a manual of psychological problems which stem from biological causation. They state that clearly such problems are based on social norms and subjective judgements about symptoms.

Of course most of the DSM disorders have elements of social construction and subjective judgement. I can't imagine many people, psychiatrists or otherwise, would disagree with that. So attacking the proposed new DSM on the basis that the disorders don't have a clear underlying biological causation is to misunderstand the reality of the manual.

The APA might officially say that these are disorders with a biological basis (and they are right insofar as every aspect of us has a partly biological basis) but ultimately the DSM is a collection of symptoms that people present with to psychiatrists irrespective of their origin. Then the task is to somehow make sense of these symptoms in larger units of regularly clustered symptoms and to label these clusters in a taxonomy.

I believe there are multiple benefits to this.

But the BPS did complain many times in their document that these symptom clusters and their nomenclature are unhelpful because they are not up to the standards of medical diagnosis:

"Diagnostic systems such as these therefore fall short of the criteria for legitimate medical diagnoses."

They are beating the APA up for using a concept of illness for what they term normal individual reactions. The reality is that if someone ends up presenting in front of a psychiatrist they need to be "ill" or they are not going to get treatment, be it paid for by the state or by a health insurance company. The insurance aspect is the real reason why there are diagnoses which cover everything possible in America. A DSM code simply has to be entered into the insurance form or treatment will not be paid for and therefore not provided.

I am saying that in reality the DSM and its use is so much more than a manual which categorises biologically based illnesses. And to beat the APA up because the DSM falls short of the standard of medical taxonomies is to misunderstand and underappreciate the totality of what the DSM is and how it functions.

The BPS paper essentially is a document attacking the professional domain of psychiatrists, and it is attacking it in the same manner as droolers from scientology or disgruntled former clients that it is invalid because it has not established the biological basis for the disorders as well as other medical nosologies.

This is exactly what I suspect motivates the dsm, insurance and time off from work.

THey need to pathologise normal things like grief and bereavement so someone can get two weeks off or get their insurance to cover their therapy.

Also, imo psychiatry and pschology, diagnosis and therapy are arts, trying to be science.

The psychs do deserve criticism. A friend of mine has been doing a lot of reasearch on this and he came across a stat that the average amount of time before a psych interrupts a patient who comes to present is EIGHT SECONDS!

sambuka41

metrovelvet wrote: »

The psychs do deserve criticism. A friend of mine has been doing a lot of reasearch on this and he came across a stat that the average amount of time before a psych interrupts a patient who comes to present is EIGHT SECONDS!

Is psych as psychologist or psychiatrist? Or psychotherapist or psychoanalyst? How did your friend get that figure, are they observing sessions? What type of sessions?


In response to the BPS response I think they have hit the nail on the head for one or two disorders, what in the name of god is a Paraphilic Coercive Disorder :mad: Personally I think that is horrendous. Not every bad thing people do is caused by a "disorder". I'm pretty shocked, going off to read a bit more about the rationale behind this entry as a disorder. I think BPS are right, this will be wrongfully used a defense against rape in the court system.

psycjay

In my opinion this is a very unprofessional response from the bps. Just look at the reference list, 5 out of 7 are by the same author, Joanne Moncrieff and include her best-selling pop book "the myth of the chemical cure". This is on a par with a 1st year undergrad essay, not what you would expect from an organisation such as the bps.

Also, why did they bother with the individual analysis of specific disorders when all they have done is a simple copy/paste.

I have issues with the medical model of mental illness but psychologists, psychiatrists, and researchers need a framework to organise the available evidence. Without this, treatments cannot be assessed properly. Yes the DSM needs a major scientific overhall, and this is what the bps should be suggesting, not trying to shrug it off with a generic, pop book response.

hotspur

Chamade wrote: »

Hotspur you said in your earlier post that the BPS didn't understand the context in which the DSM exist but it does not just exist to inform Insurance companies, it is also used in the context of mental health and to inform around issues, whether you are a client or practitioner etc.
Insurance companies are informed re mental health via the DSM so if changes were made to it's structure then why would that make a difference to them, as where did they get their information in the first place.

If a client arrived with let's say 4 of the criteria for depression instead of the required 5, and the therapist could see quite clearly that this person was really struggling, does that make their depression less real.
It works both ways.

I found your reference to Scientology unhelpful as the authors of the BPS letter are well informed and respected Psychologists.

I was in no way implying that the totality of the context in which the DSM exists is the American insurance environment. In fact I was alluding to the fact that the DSM is a very important dynamic social document which does a very great deal more than provide a manual of biologically based psychological disorders. The insurance comment was merely to illustrate the reality that the very large number of codable disorders now in it is influenced by insurance compliance necessity.

Insurance companies in America want to pay out as little as possible and insist on a codable disorder. I have read numerous clinical vignettes by American psychiatrists where they have plucked a codable disorder from the DSM for a client who didn't fulfill the criteria just because it was necessary in order to give them treatment. This is not the APA forcing that, it is the insurance industry.

You are absolutely correct when you say that "it is also used in the context of mental health and to inform around issues, whether you are a client or practitioner etc." I think the BPS miss much of that function when they complain about the science behind the biological underpinnings of disorders and medicalisation. I'll post a link to a post I wrote on here before where I explained my view on this, although it is not a view I have seen shared by anyone else.

The scientology and disgruntled former clients bit were references to what has gone on on this forum. It was before your time but we were bedevilled by a scientology guy who was rabidly anti-psychiatry (because scientology tries to exert domain over the mentally ill and offer "solutions") and who would berate the field for being unscientific all the time. The disgruntled former client was trying to have a dig at someone who has posted on this thread who is either that or just a troll.

This is the previous post I made explaining my view of the DSM:
http://www.boards.ie/vbulletin/showpost.php?p=63564101&postcount=25

metrovelvet

sambuka41 wrote: »

Is psych as psychologist or psychiatrist? Or psychotherapist or psychoanalyst? How did your friend get that figure, are they observing sessions? What type of sessions?


In response to the BPS response I think they have hit the nail on the head for one or two disorders, what in the name of god is a Paraphilic Coercive Disorder :mad: Personally I think that is horrendous. Not every bad thing people do is caused by a "disorder". I'm pretty shocked, going off to read a bit more about the rationale behind this entry as a disorder. I think BPS are right, this will be wrongfully used a defense against rape in the court system.

Sorry psychiatrist is what I meant. I cant remember where he got it from, I will try to find out. He didn't get it from observing sessions himself, but from research he is doing.

The paraphillic co oercive disorder I imagine has something to do with the pedophile issue that they are constantly running into trouble with because as scientists they cant get moral about things. So they call it a disorder instead.