DSM5 in Distress

The DSM's impact on mental health practice and research

Why Social Workers Should Oppose DSM-5

Because they bring a missing and much needed perspective

Social workers make up by far the largest single constituency among all the potential users of DSM-5, a plurality of over 200,000 mental health clinicians. Until recently, they have been silent while psychologists, counselors, psychiatrists, the press, and the public have all strongly opposed DSM-5. Things are changing. Recently, two prominent social workers have stepped forward to explain why it is important for their profession to take a stand on DSM-5.

 Jack Carney, DSW, is a social worker with over forty years in the public mental health system as clinician and program director. Dr. Carney writes:

 "Where are the social workers? Where are the NASW and its local and state-wide chapters? Over 12,000 individuals mental health professionals have publicly declared their concern at the planned 2013 publication of the DSM-5. They’ve signed the petition launched six months ago by the Society for Humanistic Psychology requesting that the DSM-5 Task Force delay publication of the new DSM and subject it to an independent scientific review. Fifty-one professional organizations have also endorsed the petition. It is extremely puzzling that the National Association of Social Workers and its local affiliates are not to be found among them."

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 "So what’s going on with social workers? It’s almost like asking 'What’s the matter with Kansas … ?' It seems like they and their professional organizations are voting against their own self-interest... Ultimately, however, most social workers, like most Kansas voters, are not motivated by self-interest but by core values and beliefs. Their acquiescence to the DSM-5 as currently composed signifies for me an abandonment of core principles—service to others; pursuit of social justice; respect for the worth of the persons being served; the importance of human relationships; and the salience of integrity and competence in social work practice (Code of Ethics @ www.socialworker.org)—and seriously undermines their fundamental mission of helping those who need it."

 "The Open Letter which the Society for Humanistic Psychology states that 'the proposal to lower diagnostic thresholds is scientifically premature and holds numerous risks … (that) increasing the number of people who qualify for a diagnosis may lead to excessive medicalization' and the increased prescription of neuroleptic medications, with all their attendant risks."

 "The DSM-5 Task Force will soon announce its last public commentary period—check its website @ www.dsm5.org—after which it will begin to finalize the new edition. Accordingly, if you’re a social worker dismayed with a public mental health system in disarray, alarmed at the distortions resulting from the system’s sole reliance on the biomedical model, determined to re-commit to core social work values and promote change in a system that no longer works, here’s what you need to do:

1. Read the Open Letter and sign the petition … http://www.ipetitions.com/petition/dsm5/;

2. E-mail the Board of Directors of NASW and ask them to endorse the petition … President@naswdc.org;

3. Spread the word to your social work brothers and sisters. There’s still time to put a stop to the DSM. Don’t mourn, organize!!"

(excerpted from "1984 & DSM5 Revisited: Where Are the Social Workers?" ... posted 3/27/12 on www.madinamerica.com)

 Dr Joanne Cacciatore is a university researcher who studies grief, the founder of an international foundation to support grieving parents, and the writer of a blog on grief that attracted 100,000 viewers in its first ten days. Dr Cacciatore writes: "It appears that APA is moving forward in its willful quest to remove the bereavement exclusion from DSM-5—despite the vociferous concerns expressed by 51 mental health organizations, practicing clinicians of all disciplines, two Lancet editorials, more than 100 articles in the world press, and the appeal of more than 100,000 grievers worldwide. Recently, I exchanged letters with the president of APA—but to no avail. Indeed, he was polite, but the letter did not address any of the strong arguments against the DSM-5 proposals."

 "Frankly, social workers have a big stake in this because these changes will adversely affect our clients. They are at risk for being inaccurately diagnosed and possibly prescribed psychiatric medication as a first line treatment. There is no evidence that these medications work in treating grief or in any of the other new disorders suggested by DSM-5."

 "Social workers have been left out of DSM-5 process, with no representation and no consultation. Should those of us in social work who so fiercely oppose DSM-5 changes continue to remain silent? My area is bereavement and it is clear that those who serve the bereaved must move from compassion to action. Current DSM proposals are over-reaching and fail to heed the warnings of critics, many of whom have spent decades in direct psychotherapeutic practice with those who are suffering."

 "According to the ethical standards of our discipline, social workers have a duty to act on the behalf of those we serve. In particular, we have a responsibility to influence peripheral forces that would further harm vulnerable populations. The acutely bereaved are defined in the literature as vulnerable and many state laws protect them from exploitation (for example from predatory funeral practices). The bereaved are often unable to use their own voices and need us to advocate for them."

 "We must also speak up for the many other people—especially children—who will be over-diagnosed by DSM-5 and may receive harmful and unnecessary medications that can cause huge weight gains. Social workers should protect people from being medicated when they don't need it and from the stigma of being labeled with illnesses they don't really have."

 "What can social workers do? We can raise our voices individually and as a profession. Write to the DSM-5 work groups and APA Trustees and to the NASW leadership. Sign the American Psychological Association's 32nd Division's petition. Work with clients on a sliding scale so that you can forego the diagnostic process when it is unnecessary. Volunteer in your community to help those who suffer. There are many, many wonderful nonprofit groups that provide direct, compassionate, mindful services to families."

 "And, if we cannot use our voices to alter the trajectory of DSM-5, we may be forced to take political action at the state and congressional levels and to organize a boycott of DSM-5."

 Thanks Drs Carney and Cacciatore. It is clear that DSM-5 has lost touch with clinical reality. It has been prepared by researchers with little real world clinical experience and little understanding of how their proposals will be distorted by drug company marketing. With their very different and necessary perspective, social workers have an important responsibility to protect their clients from over-diagnosis and the consequent excessive exposure to medication. Previously, social workers have been given no role in the development of DSM-5. At this eleventh hour and before all the final decisions have been set in stone, social workers need finally to have their say and their message should be heard.

 

Allen Frances, M.D., was chair of the DSM-IV Task Force and is currently professor emeritus at Duke.

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