Since the creation in 1952 of the Diagnostic and Statistical Manual (DSM), the go to book for the classification and diagnosis of mental disorders in the fields of Psychiatry and Psychology, there have been issues with its content and use. The main problem, and it’s a HUGE problem, is the reliability and validity of the text. As it stands it seems not to be a consistent reliable measure and it doesn’t seem to measure the intended variables or constructs accurately as well. In fact, Thomas R. Insel, M.D., Director of the NIMH has recently stated the agency would no longer fund research projects that rely exclusively on DSM criteria due to its lack of validity (Insel, 2013). The treatment of symptoms versus making sound diagnosis’ has been the modus operandi of most therapists due to this serious flaw in the text. The inability to determine causality of symptoms is also a serious issue and would seem to greatly shake the legs that support the claim of psychotherapy to be a true science in the classic sense. How, if possible, can these issues be resolved within the framework of the scientific method? And are there possibly any answers that may lie outside this framework that could help? It would seem that at the end of the day the healing of hurting and unhappy people is more important than trying to shore up an academic ideology that is clearly failing in its attempts to play a role its not suited for
In April of this year I sat on a discussion panel at Long Island University in Brooklyn, New York with four PhD psychologists, a Licensed Mental Health Counselor, and a Registered Nurse/Massage Therapist to speak to graduate students and currently practicing psychotherapists on the subject of “Spiritually, Mental Health and Well-being.” This was the title of th
e event. Even though I am just an undergrad student in psychology at Penn State, the facilitator of the event knew of my eastern medicine background in psychology that I have been practicing for 15 years now. It seems that there is a crisis especially in the realms of clinical and counseling psychology where things are just not going right when trying to psychotherapeutic work “by the book.” Students and therapists spoke of frustrations with diagnosis’ and assessments when using the DSM, they had issues and concerns with objectivity and subjectivity in dealing with their patients, and they were just plain lost, untrained and unprepared to deal with issues of spirituality that arose in their sessions. Their textbooks and teachers had very little to say about this most elusive of unquantifiable variables. This situation, I have heard from speaking with many practicing professionals, is wide spread. And the ever increasing disappointing and damaging results of pharmaceutical-based psychiatry are more and more troubling. This practice parallels the drug cartel like proliferation of pharmaceutical medicines fostered on the American public by drug companies and physicians to treat both major and mundane conditions regardless of the side effects.
So what do we do then? If we are going to be scientists and work within the realm of the scientific method we must create interventions based on experimental models that feature variables we can actually operationalize and measure. We also need to be as far removed from our experiments or our presence will “contaminate” the results and we won’t get good data, good information, or what’s considered to be the scientific “truth.” No one seems to have an idea of what should be done. There’s no other book or guide, no other standard that is academically respectable to the western view of healing and knowledge to turn to. So therapists seem to focus on treating symptoms only while not understanding the casualty of what they are treating, and are “winging it” to fill in the blanks. I must say at this point that I am speaking in broad generalities. There are plenty of sensitive and hard working therapists that do the best they can with what they have, but they often come up on the short end using the tools they’ve been given to help people heal. Also I happen to be a lover of science. Before getting into psychology I worked in engineering and am considering, after getting my master’s in psychology, to return to school to study physics just for fun. But when it comes to treating the “study of the soul” like other sciences we run into serious trouble. We also run into trouble when we ignore history and other cultures that have hundreds and thousands of years on us in the healing department.
I feel a big part of the problem with the DSM and a general lack of understanding of causality in mental disorders, is the fallacy that the fields of psychiatry and psychology make an attempt to be sciences in line with physics or chemistry when in fact they are actually more art than science. The late philosopher Alan Watts in a lecture before a group of psychotherapists in 1969, spoke of “the amazing superficiality of it all” in referring to western psychotherapy. https://www.youtube.com/watch?v=Wz_wiaTe5ug He went on to say a great many thought provoking things including that psychotherapists were not scientists so much as they are artists. Healing artists. And this is something from my years of personal experience I highly concur with. Being an artist would feel, I suppose very daunting and complicated to one trained in objectivity and logic like scientists generally are. The artistic spirit is one of self immersion into ones art in order to create a satisfying end result whether that’s a great piece of music, an inspiring painting or helping a person heal integrally on all levels of their being, This artistic or dare I say spiritual or transcendent aspect that Watts speaks of is, I feel, the complex situation spoken of in the following quote by DSM-III chief architect Robert Spitzer and DSM-IV editor Michael First in 2005, “little progress has been made toward understanding the pathophysiological processes and etiology of mental disorders. If anything, the research has shown the situation is even more complex than initially imagined, and we believe not enough is known to structure the classification of psychiatric disorders according to etiology” (Spitzer & First, 2005).
Unlike the western method of psychotherapy and medicine in general, eastern medicine and specifically Chinese medicine takes a much broader view of life and has a different more inclusive scientific method. For those who have never looked, eastern medicines 3,000 year history is replete with experiments, case studies, tons of empirical tests and data, volumes and volumes of books, lots of clinical data, and famous medical practitioners that were lauded for their skills, insight and for moving the healing arts forward. Chinese medicine has an etiology for a myriad of conditions physical, emotional and mental, and this is due in great part because unlike western medicine, eastern medicine has a working definition of health, that being in short, the smooth and natural movement of Chi or life-force energy within the body, which though it cant be quantified in western terms can be observed, felt, experienced, qualified and documented in very empirical terms (Hammer, 2012). The best resource on this topic is a book called Dragon Rises, Red Bird Flies by Dr. Leon Hammer, who is both an M.D. Psychiatrist and Doctor of Chinese medicine (Hammer, 2012). Although there are fundamental differences in the approaches, both eastern and western medicine and psychotherapy can live quite harmoniously with one another to great healing effect. I have seen this many times and have used this blending approach if you will myself. In fact I always use it. We are already seeing more and more signs of traditional psychotherapy opening up to meditation, awareness practices, focused breathing and other methods of therapy that were once given the cold shoulder, but I think foundationally there needs to be a shift in how academia regards what psychotherapy really is. As far as I can see most of the new openness in embracing eastern concepts hasn’t necessarily been by the curious and open minded, but has been born more and more out of necessity. It seems nature is trying to tell us something about healing if we would just listen.
What is to become of the DSM? Where will classically trained psychotherapists go for an understanding of etiology that is in harmony with symptomology? What will therapists do with clients that need to deal with the unmeasurable aspects of their lives and experiences that are “transcendent” but are subjectively a very real part of themselves? There are ways to do this. There is information that exists. There is an overwhelming body of knowledge that exists on dealing with these very questions. Again my knowledge only extends to Chinese medicine and by further extension Japanese medicine. The Indian auyervedic traditions and other medical traditions around the globe have a lot to offer if the leaders and policy makers in academia would care to look. Until then it seems that small pockets of individuals and groups are piecing together their own workable fusions of east and west in order to help their clients and patients. Maybe in time this will produce a text or a methodology that may replace the DSM. But if the academic powers that be insist on continually squeezing psychotherapy into the scientific method mold, even if they throw out the DSM, whatever new guide comes of this will still go the way of the DSM. It’s time for new, fresh thought on the subject and an opening up to what’s right before our eyes. Fear, ignorance, and pride need to be put on the side which can be a tall order! Spirit, if you will, has way too many intangible variables to quantify. The nebulous playground of spirit and energy is where eastern medicine lives and does its thing. It seems to me that a practice, culture or method that has a proven track record over millennia and tons of empirical data to back it, and that is expert in dealing with such complex intangible variables should be given an honest critical look on it’s own terms (not necessarily the scientific method!) as to how it might solve some of the problems troubling traditional psychotherapy today. Jus’ sayin’!
References
Hammer, L. (2010). Dragon Rises, Red Bird Flies. Barrytown, NY: Station Hill Press.
Insel, Tom. “NIMH Director”. Director’s Blog. NIMH Website. Retrieved October 12, 2014.
Spitzer and First (2005) Classification of Psychiatric Disorders. JAMA.2005; 294: 1898-1899.