Guest Blog: Dancing with DSM

Psychiatrist Glen Simblett reflects on what DSM diagnosis might mean in the consulting room and offers the unusual metaphor of dance to think about how we might best help people.

Doctor and DSM

Photo: Dino ahmad ali

Bring up the topic of DSM 5 and you are immediately engulfed in controversy. It is an intensely polarising topic with people either challenging the relentless medicalisation and drug treatment that it seems to represent, or conversely pointing to the many examples when people have found DSM diagnosis and drug treatment helpful.

DSM does tend to pull people into particular positions in relationship to it, and in the process, often produces conversations that collapse us all into argument and challenge of the “opposing” viewpoint. Rather than engage in debate about whether DSM is good or bad for people, as a therapist I am a lot more interested in exploring different questions. Here’s a question that has meant more to me:

‘What types of relationships and conditions are needed for DSM knowledge and practices to add to personal agency and assist people in reclaiming their lives from problems?’ 

To answer this, I have to understand some of the dangers that lurk within DSM knowledge and practices. Then, I think I need to develop some different understandings and ways of working in order to counter those dangers. I have to understand how I can dance with DSM in different ways and different styles as a person, a therapist and psychiatrist. 

Borderline personality disorder: Abandon the label, find the Person

Steven Coles

Borderline Personality disorder:
Society's illsdressed up as yours?
Picture: MargaritaJP

In 1980 the mental health industry invented a new diagnostic label, one of many, for the 3^rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM III). The American Psychiatric Association (APA) presented DSM III to the world as a scientific revolution in psychiatric understanding. If people suffering emotional distress had accepted the APA's statements about the new manual, they would have rejoiced that such a wealthy and powerful organisation had put its energies into making sense of psychological suffering. The vast majority of people receiving one of these new labels had experienced great trauma - sexual abuse, extreme life events and repeated abuses of power. Quite a progressive move by the APA then: understanding the effects of power on people. Psychiatrists could show care, understanding, and perhaps even provide a sense of solidarity to people who were marginalised. Unfortunately, in 1980 the APA willed Borderline Personality Disorder into being. The APA's idea of empathy and understanding led to vast numbers of survivors of abuse being labelled as disordered individuals.

In many ways the diagnosis of BPD is an easy target for criticism and satire. The diagnosis of BPD is defined by a series of social and moral judgements, applied to people who have been traumatised and dressed up as a medical problem. If we had a friend who revealed to us after years of secrecy and shame that they had been repeatedly sexually abused as a child, our first response is unlikely to be “your personality must be really disordered – no wonder I've felt like rejecting you”. Instead we would show care, be amazed at their survival and probably feel anger at the perpetrators of abuse - basic common sense and decency. Sadly when it comes to psychiatric diagnosis good sense does not prevail. The survival of psychiatric diagnoses is in many ways an astonishing feat of magic; its supporters have woven a spell that repels good sense, compassion, logic and evidence.