Is it time for psychiatry to lose its monopoly?

There was a fascinating May 11 New York Times article that should be of interest to those of us who work in the mental health field. The article was written by Allen Frances, MD, who was chairman of the task force that produced DSM-4, which is widely known as the bible of mental health disorders. Dr. Frances has concluded that it is time for psychiatrists to lose their century long monopoly on defining mental illness. Dr Frances wrote this:

I was heavily involved in the third and fourth editions of the manual but have reluctantly concluded that the association should lose its nearly century-old monopoly on defining mental illness. Times have changed, the role of psychiatric diagnosis has changed, and the association has changed. It is no longer capable of being sole fiduciary of a task that has become so consequential to public health and public policy.

Wow. This would indeed produce a revolution in mental health care if it were to happen.

When I was in my Masters program in 1988, the professor often quipped that the course was about insurance companies, and the insurance companies were about the Diagnostic and Statistical Manual of Mental Health Disorders. Our job was to learn how to get paid properly by insurance companies and to do that we needed to understand the language they spoke. Seemed cynical, but true at the time. The professor had an existential bent by the way and we always knew he believed the system was arbitrary and ridiculous, but it was the system in which we were forced to work.

I had another professor of child psychotherapy who argued that the child section of the DSM should have about seven broad categories instead of the dozens of diagnoses that were included in DSM-3 at the time. That also seemed to make a lot of sense to me.

Then, I went to a Scott Miller workshop and heard for the first time that there was essentially no way to effectively select a specific treatment model that would produce any better results than any other model or technique, based solely on the psychiatric diagnosis assigned. In other words, the diagnosis does not matter as much as we like to think it does.

I took these factors to heart when I synthesized the Interpersonal Wisdom approach. But I have a more radical idea that even this brave physician who is sure to take a lot of heat from his colleagues, would find hard to fathom.

All treatment is about relationship and resilience. What is the capacity of the human being in front of us to withstand environmental or physiological attacks on his best functioning? How can we be in relationship with that human being in such a way that we can help that person be his/her best self? Sure, we provide a lot of information and engage in a whole bunch of behaviors to try to help, but essentially what we are doing is containing, loving, and encouraging. Uh, Oh, I let my hippie alter ego out again. Oh, well.

I admire Dr. Frances for his courageous stance, and believe a change such as he is suggesting would turn the mental health field upside down – in a good way. But there is a deeper paradigm shift already occurring out here in the talk therapy community that contains even more possibilities for human flourishing.

About Kevin Kervick

Licensed Marriage and Family Therapist, Teacher, Mentor, Community Builder.
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