The Psychological Society of Ireland



The Psychological Society of Ireland,
Floor 2, Grantham House,
Grantham Street, Dublin 8, D08 W8HD.


Thursday 23rd May 2013

 Psychological Society of Ireland welcomes statement from UK on the need for change in relation to functional psychiatric diagnoses


The Psychological Society of Ireland (PSI) welcomes the recent position taken by the British Psychological Society (BPS) Division of Clinical Psychology (DCP) in believing there is a clear rationale and need for a paradigm shift in relation to functional psychiatric diagnoses. The BPS DCP’s position statement, which was released earlier this month, raises concerns over the use of current classification systems as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM 5) and the International Classification of Diseases: Classification of Mental and Behavioural Disorders (ICD-10).


A number of PSI members have expressed concern over the use of these powerful systems which are limited in their capacity to provide a clear understanding of the complexities of mental health. Concerns around the scientific basis of the American Psychiatry Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) have been voiced due to the system being more categorical than diagnostic, with the validity and reliability of the system being questioned. The DSM system is commonly used in a range of varied fields - psychiatry, psychology, health insurance and the pharmaceutical industry.


The American Psychological Association (APA) has raised similar concerns in relation to the DSM 5 to those raised by the BPS. The APA expressed concerns about the potential harm any diagnostic system might have if it were to increase the potential for over-identification of illness and, therefore, the possibility of unnecessary treatment. The APA called for the DSM 5 Task Force to adhere to an open, transparent process based on the best available science. The International DSM 5 Response Committee (RDoC), set up by the American National Institute of Mental Health (NIMH), has also highlighted a number of issues around the DSM 5, and recommended the manual be subjected to an external scientific review process. NIMH wants to move away from a simple diagnostic approach to mental health and feels that it is no longer adequate to just look at symptoms without taking other factors into account.   


The DSM, since its inception, has mostly followed the “medical model” of diagnosis by adopting a check-list approach to symptom presentation with little reference to the person’s coping style or personality, or any reference to past stressors or current circumstances. There are serious concerns that the DSM 5 lacks objectivity and integrity as a diagnostic instrument. 


The aim of DSM 5 is to develop a psychiatric classification system and starts from the assumption that psychiatric disorders are brain disorders and mental health difficulties are caused by neurobiological factors. There is little or no evidence for this claim.


The DSM diagnosis system is rarely an explanation. Mostly it is just a list of surface symptoms without any attempt to understand the underlying causes. While the DSM labels may be useful in research and allow for a common language among clinicians, in clinical practice the labels often distract or obscure the real issues and rarely point to the correct intervention or treatment options. The DSM 5 has an increased emphasis on biological theory along with reduced acknowledgement of sociocultural contexts and causal factors. The DSM 5 attempts to provide a common language for describing psychopathology to enable reliability among clinicians so that they use the same terms in the same ways; however, its weakness is its lack of validity. Clinicians working in the area of mental health are searching for a more clinically credible way of helping individuals and their families conceptualise their difficulties and find solutions. Clinical experience indicates that most presentations of mental health difficulties can be located on a spectrum with different levels of severity. The DSM 5 is primarily a categorical approach and for the most part does not allow for this dimensional approach to human distress. 


There are concerns that, in some instances, psychiatric and other mental health research can be tainted if it is financially contributed to by multinational pharmaceutical companies wishing to create a market for their drugs. The DSM system is frequently criticised for its financial ties with the pharmaceutical industry, with a number of members of the DSM 5 Task Force having links to drug companies. In this regard it is noted, for example, the number of overactive or inattentive children on Ritalin and the number of adults with low mood on antidepressants has never been higher.


Dr Michael Drumm, Principal Clinical Psychologist and Past President of the PSI states: “The over medicalising of human distress, in my clinical opinion, is inappropriate. Despite its many promises, the biological approach to mental health has achieved only a very limited amount of success. There is no evidence to support the idea that depression is solely caused by a “neurochemical imbalance.” There are real concerns that the DSM 5, which has been criticised for its poor scientific basis, will further lead to the medicalisation of normal human emotions and common mental distress will get diagnosed as a disorder.”

On May 30th and 31st, Ms Nessa Childers, MEP, will host a conference in the University of Limerick (UL) entitled De-medicalising primary mental health care: Can we afford to, can we afford not to? MEP Childers states: "The conference I am hosting on de-medicalising of Primary Care is intimately related to the reclassification system of the DSM 5. The new categories would seem to pathologise and medicalise states of mind which have very little to do with minds and much to do with the body. The assumption being that such states are treatable with psychoactive drugs. We know this to be incorrect. As with all such changes, close attention must be paid to any vested interests who might benefit from such questionable classification. The biomedical model of mental illness risks denying the fundamental human space we all occupy."


This information was sent as a press release which was issued from the PSI on 23/05/2013.  To view the BPS DCP's position statement please click here

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