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. 

Am I Still Bipolar? Emerging from the Shadow of the DSM

Fay Thomas

What if it's not our brains
that are the problem?
Photo: Bohlega et al 

I am excited. Almost as excited as I was the day the Berlin wall fell or Nelson Mandela was released from jail. For me, the current debate around the utility of the DSM5 and psychiatric diagnosis feels that big. It feels that big because I have been personally touched by a madness from which I was told I would never recover. My only sibling has likewise lived in the shadows of diagnosis, similarly labelled and without any real hope for much of his life. I was labelled bipolar 1 and he as schizophrenic. Of the two labels, I must confess to preferring mine. Bipolar is somehow a bit sexier than is schizophrenia - in these days of celebrity confession, anyway.

But a quarter of a century ago when I was first given my diagnosis, I was a manic depressive and there didn't seem much that was glamorous about that. Celebrities did not then come out of the closet and admit to their diagnoses or discuss their trials in Hello. It was only historical geniuses like Virginia Woolf and Hemingway who were found on lists of the similarly afflicted. And that was only because they were dead. 

Guest Blog: Bipolar or Not?

Psychiatric labels can be both helpful and confusing. In the light of the current DSM debate, guest blogger Fay Thomas writes about her struggle to hold onto a normal response to personal grief having been diagnosed with bipolar disorder some years ago.

Being labelled bipolar
casts a long shadow
Photo: SigmaOne

'Are you suicidal?' asked the doctor, peering at me kindly as she offered tissues for my tears. I wanted to answer truthfully, but it felt difficult. I hoped the answer was no, because I would not have done anything to harm myself, but my mind was full of dark thoughts. So I answered no, which seemed dishonest, especially since I had failed to tell her my history.

As a much younger, highly-distressed woman, I was given a label of 'bipolar mood disorder type 1' to describe my see-sawing moods. They cycled between delusional elation and the depths of despair. Aged 28, I had made a serious attempt to kill myself which led to a traumatic series of hospitalisations. My memories of those years are grim, painful and still difficult to articulate. I believe some of the treatment decisions made on my behalf were not in my best interests. Incarcerated and robbed of my own voice and power, it would be hard to trust medics again, especially with my mental health.

Prior to my GP visit, it had been 23 years since I'd experienced serious mood deterioration. For thirteen of those, I had been medication-free - unusual for someone with the bipolar label. Recovery had been a long, hard slog which presented serious risks. It had meant doing my own reading and acting on my own hunches despite the warnings of doctors.

Guest Post: In Praise of Creative Maladjustment

We are pleased to have our first guest post. In this entry Peter Kinderman writes about the  role of psychologists and makes a plea for social engagement.

Peter Kinderman

What would he think psychologists
should be doing?
Photo: Discover Black Heritage

“On September 1^st 1967, the Nobel Prize-winning civil rights leader Martin Luther King Jr. delivered a speech entitled “The Role of the Behavioral Scientist in the Civil Rights Movement” to the American Psychological Association. With eloquence and passion, Dr. King championed the civil rights struggle and spoke about how people like you and me could and should support the civil rights movement.  This speech is particularly relevant today.

“There are some things in our society, some things in our world, to which we … must always be maladjusted if we are to be people of good will. We must never adjust ourselves to racial discrimination and racial segregation. We must never adjust ourselves to religious bigotry.

“We must never adjust ourselves to economic conditions that take necessities from the many to give luxuries to the few. We must never adjust ourselves to the madness of militarism, and the self-defeating effects of physical violence. … There comes a time when one must take a stand that is neither safe, nor politic, nor popular. But one must take it because it is right…”

If there were a Martin Luther King for 2013, he or she would call on us to speak out, to identify and to condemn those things that should be condemned. We should refuse to tolerate the unacceptable and to act accordingly. That modern Martin Luther King would turn to academics and psychologists and call on us to analyze – using those particular skills and perspectives that we possess – the psychological and social mechanisms that sustain and maintain those unacceptable current realities, and similarly to use our particular skills in psychological science to research social and psychological mechanisms that could support positive change.