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. 

The Lament of a Black Swan: I don't need my defamatory label!

Fay Thomas

Now surplus to requirements?
Photo:  christmasstockimages.com 

The first time I told someone about my bipolar label, it was an agonisingly big deal. I rehearsed and thought it through carefully. Finally, using the language of the times, I declared my manic depressive 'otherness' to a friend. I was met with a hug, some questions and reassurance. It makes no difference to those who hold you with affection. But other situations can get tricky. Do you spill the beans on a first date and if so, how? Or do you wait until it's serious and then cope with the feelings of betrayal and humiliation that arise? Do you tell before you meet his parents, or wait until the night before you move in?

I remember one partner who was happy to have a manic-depressive writer for a girlfriend. A journalist with a formidable reputation, my mental health status fulfilled his romantic notions of living out life Bohemian style. The first time he witnessed my ascent into full blown mania he seemed intrigued but stayed around to discuss it. After all, someone who stays up all night to order flowers for everyone they know, might be a fun person to live with (sometimes). But descent into the murky depths of a depressed hell usually followed my upswings. Most partners find it difficult to fathom why you're still not dressed at 3 o'clock or can't find the energy to get out of bed. And prior to marriage there were hurtful discussions about children and whether or not you could/should have them. What was the risk of offspring being similarly afflicted?