DSM-5 response

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Re: DSM-5 response

Post by coolblue » Tue May 14, 2013 9:52 am

matt.berlin wrote:So to address some of the points above:

On the epigenetics stuff, whilst I fully accept that genes and biology has a role to play in our experiences of the world (given we are all biological beings with DNA it seems silly to suggest otherwise), in practice it seems that genetic and biological factors take undue precedence how difficulties and distress are understood. Read argues in "The bio-bio-bio model of madness" (quoting then APA President Leo Sharfstein who said: "We must examine the fact that as a profession, we have allowed the bio-psycho-social model to become the bio-bio-bio model") that the psychosocial often gets relegated in the use of the biopsychosocial model to of "'triggers’ of an underlying genetic timebomb" which are relevant "only in those who already have a supposed genetic predisposition".
Completely agree.


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Re: DSM-5 response

Post by JCBird » Tue May 14, 2013 12:12 pm

Gilly wrote: ha! its a nice quip, and whilst its an important thread in the background of this whole debate, part of me feels that its not really appropriate in this sense. I would most likely make the argument that psychosis following birth isnt a "normal" reaction to birth.
I would argue it the question of 'what is normal' is actually central to the debate as diagnostic systems have at their core the notion of disorder and abnormality. They are saying that this syndrome and collection of symptoms doesn't fit in with how we expect people to behave / cope, and therefore is abnormal enough to reflect an underlying disorder within the individual.
Gilly wrote: I would disagree, whilst i agree with you that coping is based on all those factors, i think there are certain reactions that can be deemed to be abnormal ways of coping in a situation. Lets take an example of say...If you bring round your new baby for me to meet, and when you walk through the door, I scream at the top of my lungs, jump through the window 'action hero' style and run as fast as my legs can carry me - I wouldn't define that as a "normal" reaction.
You are right, I probably would look at you funny if you did this.. But who's to say that in a different county with a whole different set of cultural norms and social expectations you might be thought of as abnormal if you didn't respond like that?? For example, western notions of grief usually presume that the normal way to respond when a loved one passes away is to cry and be sad and to talk about it. When someone doesn't show that emotion and carries on as normal, we presume they are repressing their emotions and this is not healthy and we must prompt them to open up and express these emotions. However, in Islam, outward expressions of sadness and crying at a death is seen as inappropriate because it is seen as disagreeing with the will of god. Similarly, in Roma/Gypsy culture it is the norm to cry and wail very loudly in public to allow the spirit to hear their sadness - a behaviour that would be viewed as inappropriate for the stiff upper lipped Brit! What is a normal way for me to cope with the death of a loved one will be abnormal for another person, and vice versa.

This really fits in with the DSM and notions of mental disorder which basically reflect that people showing behaviours that don't fit with western ideas of normality are deemed as disordered and ill. It's not to say that psychosis is 'normal' after having a baby, clearly that person is hugely distressed and she needs support. But even if you say her response is understandable, the moment the language of normal and abnormal reactions is brought in it has the assumption that even considering what she has been through, she shouldn't respond like that and it doesn't make sense, and that we know better about how all people should behave and cope.

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Re: DSM-5 response

Post by alexh » Wed May 15, 2013 7:20 pm

BenJMan wrote:
CupcakeFairy wrote: He suggested instead that children below the age of 5 be given a diagnosis labelled ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations).

I'm sure his talk was interesting and the perspective sounds intriguing but just because I'm awkward I will pick up on this one bit :P

Is he serious with this? Does he live in the real world of trying to explain an acronym like that to a family?! My word, find a better title for it :D
You're looking at the finger not the moon! Spoiling his point which he is making to other professionals with the acronym. The essence of the problem is that children come to attention of one professional but often have problems across domains that need to be investigated.

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Re: DSM-5 response

Post by daydreambeliever » Thu May 16, 2013 12:20 pm

Interesting debate, most people seem to agree that (with differing emphasis), biological, psychological and social factors all need to be considered when deciding whether someone has crossed a socially constructed threshold at which they are deemed to merit being offered help.

I thought I would post some of my thoughts on the threads around "normal" as I bristle every time I see the word.

My concern with the ever widening thresholds is that there seems to be this assumption in the new DSM that being "normal" is desirable, positive and we would all be better off conforming to the "normal" pool of people. If the way we cope with difficult life experience means we are different from "normal" people that means we need to be labelled and given interventions to make us "normal" again. Where is the research evidence to tell us what "normal" is and whether "normal" people are happier because of their "normal" status? I don't consider myself "normal" personally, and I've never been happier in my life than I am right now.

For me, the concept of normality as desirable is damaging to nurturing equality and diversity. For me, not nurturing diversity flies in the face of my life experience, clinical training and knowledge of the literature and particularly recovery narratives.

I would view coming to a place of self-acceptance, including the ways in which we are different to others, as key in recovery. This conflicts with the widened DSM categorical diagnoses, where to get to the point of no longer meriting them, you would effectively have to conform to "normal", and in doing so perhaps move away from accepting the way you are and finding a way to thrive that fits with your life, culture and people around you. In this sense, I think there's a risk that the proposed DSM-V poses a threat to well-being and recovery from "normal" adverse life experiences.

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Re: DSM-5 response

Post by miriam » Thu May 16, 2013 9:12 pm

Yeah, there is definitely something about social conformity going on with some diagnoses and that has some scary ramifications. I much prefer the idea that diversity is a positive thing, and that the aim is to help each individual optimise their wellbeing, happiness and ability to function well, along with ensuring the lowest possible risk of harm to others.

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Re: DSM-5 response

Post by Keyser_Soze » Mon Jun 10, 2013 9:03 pm

What does everyone make of these?

http://keithsneuroblog.blogspot.co.uk/2 ... ience.html

http://keithsneuroblog.blogspot.co.uk/2 ... ce_10.html

Have to say, it doesn't sound like our profession is being very coherent in this debate, although it pains me to say it.

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Re: DSM-5 response

Post by Gilly » Wed Jun 12, 2013 9:06 am

I think it doesnt help sometimes when Lucy is seen as a principle flag bearer - her views on diagnosis/psychiatry are very polarised and despite what she says on those blogs - when i've heard her speark she does want diagnosis replaced with formulation. It may be concerning that people may accept her position as the position all psychologists have in this debate, which can lead to this turf war/psychology vs psychiatry narrative.

I also understand Keiths position - from an outsider perspective (hes an academic) replacing diagnosis (which is argued to be lacking reliability and validity) with formulation (which is also lacking reliability and validity, and has less "evidence" around it) seems to make little sense - but obviously we as clinicians know the benefit that formulation generates in helping to form a joint understanding. I do also wonder whether Keith has gone a bit far in bashing CPs now, and seems to be personally peeved by Lucy herself.

just my thoughts :)

edit: I would also highly recommend this blog for anyone interested in this: http://psychodiagnosticator.blogspot.co.uk/
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Re: DSM-5 response

Post by Keyser_Soze » Wed Jun 12, 2013 8:55 pm

I'd agree with that Gilly. There are a multitude of opinions about formulation and diagnosis within, nevermind between professions. It is rather concerning that rightly or wrongly, LJ has been positioned as the "architect" of the DCP DSM response and as such, her views are taken to be the gospel of all clinical psychologists in this debate. I think it's a good example of an unstoppable force hitting an immoveable object. As you say, Keith's epistemological and ontological stance is on the extreme end of a spectrum, with LJ lying at the other end.

Personally, I do feel that such a key figure in this project should maybe reserve debates for professional/academic contexts rather than over Twitter, where things can (and perhaps have) been lost in translation.

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