Abstract
Since 2011, the Society for Humanistic Psychology (Division 32 of the American Psychological Association) has taken a lead in organizing an international coalition of organizations and individuals that share major criticisms of Diagnostic and Statistical Manual of Mental Disorders–Fifth edition (DSM-5) diagnosis and the search for alternatives. Inspired by the British Psychological Society’s public criticism of the DSM-5, Society for Humanistic Psychology began by drafting an Open Letter that outlines criticisms of the DSM-5. The Open Letter went on to receive endorsements from over 50 national and international organizations, and was signed by over 15,000 individuals, primarily mental health professionals. The effort to reform the DSM-5 shifted gears in 2013, when the Society’s efforts began to pivot toward efforts to organize discussions about legitimate alternatives to medical model, DSM diagnoses of human suffering. The culmination of this project was the Global Summit on Diagnostic Alternatives, which persists in several fronts to provide guidelines for the development of diagnostic manuals, and to promote scientifically and ethically sound approaches to understanding and alleviating human suffering.
Keywords
In recent years, the Society for Humanistic Psychology (SHP), Division 32 of the American Psychological Association (APA), has played a leading role in multidisciplinary efforts to reform the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is published by the American Psychiatric Association (2013). This article provides a brief overview of SHP’s contributions to the reform movement, which continues to grow and now includes thousands of researchers and practitioners, as well as dozens of psychology organizations around the world. A companion piece from the perspective of reform movement leaders in the United Kingdom appears in this same journal issue (Kinderman, Allsopp, & Cooke, 2017).
How the Society for Humanistic Psychology (APA Division 32) Became Involved
For years, humanistic psychologists had concerns about the scientific status, multicultural relevance, and ethical implications of the DSM. However, like most other mental health professionals, humanistic psychologists have been compelled to utilize the DSM, as its diagnostic codes contribute to the cultural and epistemological constitution of clinical work—both practice and training—in hospitals, clinics, and other sites of practice both nationally and around the globe. During the second half of the 20th century, critiques of the DSM by humanistic psychologists were seen as mostly theoretical and academic exercises, divorced from the actual practices and epistemological agendas of most clinical researchers and clinicians.
Then, in the spring of 2011, something remarkable happened. As the fifth edition of the DSM was being prepared by the American Psychiatric Association, the British Psychological Society (BPS) published a scathing critique of the proposed DSM-5 (see BPS, 2011; see Kinderman, Allsopp, & Cooke, 2017, in this special issue). Among other issues, the BPS raised concerns about the medicalization of normative behaviors and the addition of diagnostic categories that appeared to lack scientific validity. The BPS statement was the strongest DSM critique that had ever been published by a major psychological association. The bold nature of the BPS statement was a major reason the SHP became involved in the DSM-5 reform effort.
In August of 2011, at the APA annual convention, David Elkins was set to begin his term as president of Division 32. Elkins appointed Brent Robbins, Division 32 secretary, to chair a task force that would focus on important issues facing humanistic psychology. The BPS critique of the proposed DSM-5 was one of several issues discussed at that time. Elkins and Robbins learned that Sarah Kamens, a student representative to the SHP board and a doctoral student at Fordham University, had recently completed her master’s thesis on the public debates and discussions surrounding the proposed DSM-5. As a result, Kamens had detailed and up-to-date knowledge about the proposed content of the DSM-5 as well as the political issues related to its diagnostic categories and upcoming publication. As Elkins, Robbins, and Kamens (2012) discussed the proposed DSM-5 and the BPS critique, we found ourselves in agreement with, and inspired by, the BPS statement. We believed that our own national organization, the APA, should publish a similar public statement expressing concerns about the scientific, sociocultural, and ethical implications of the proposed DSM-5. As president of SHP, Elkins appointed Robbins, Kamens, and himself to an ad hoc task force, which we named the “Division 32 Open Letter Committee.” Elkins served as chair, and over the course of several weeks, the three of us drafted a critique of the proposed DSM-5. Because of her detailed knowledge of the proposed DSM-5, Kamens served as primary author, and Elkins and Robbins contributed suggestions and revisions. Kevin Keenan, SHP board member, also read the draft and provided helpful copyediting. Once the document was in final form, Elkins submitted it to the Division 32 board with the recommendation that it be publicly posted as an open letter to the DSM-5 Task Force and the American Psychiatric Association. The Division 32 board approved the document and recommendation. In early October of 2011, Elkins sent the “Open Letter to the DSM-5” by e-mail attachment to other APA divisions, inviting them to sign. Divisions 27 (Society for Community Research and Action: Division of Community Psychology) and 49 (Group Psychology and Group Psychotherapy) were the first divisions to sign. Presidents of these divisions, after discussing the document with their boards, contacted Elkins by e-mail to say they wished to endorse the letter. (Eventually, a total of 16 APA Divisions would endorse the “Open Letter.”) On October 22, 2011, at the suggestion of Robbins, the Open Letter was quietly posted on a petition website without publicity or fanfare. The site invited professionals to read the letter and, if they agreed with it, to sign the petition.
The Open Letter Committee hoped the petition might garner a modest number of additional signatures. But the results were unexpected and overwhelming. Within a few days, more than 1,500 psychologists and other mental health professionals had signed the letter, along with several mental health organizations. Obviously, the “Open Letter” had tapped into widespread concerns among mental health professionals about the proposed DSM-5, and the petition website gave them a way to express those concerns. Within a short time, thousands of individuals and dozens of mental health organizations had signed our petition. News agencies picked up the story and eventually more than 100 media outlets around the world covered the growing DSM-5 reform movement. These included USA Today (Rubin, 2011), the San Francisco Chronicle (Allday, 2011), the Chicago Tribune (Deardoff, 2011), Nature (Ledford, 2011), Scientific American (Ledford, 2011), Forbes (Walton, 2011), The Wall Street Journal (Wang, 2011), Psychology Today (Frances, 2011a, 2011c), ABC News (Moisse, 2012), the NY Daily News (Murray, 2012), Reuters (Kelland, 2012), the Washington Post (Strauss, 2012), Fox News (“Shyness, Grieving Soon,” 2012), the Pittsburgh Post-Gazette (Roth, 2012), The Huffington Post (Frances, 2012c), and dozens of other media in Canada, Europe, South America, Australia, and other places. The Division 32 Open Letter Committee produced a short video that called attention to social justice issues related to the proposed DSM-5. More specifically, the video raised concerns that the lowering of diagnostic thresholds on some existing diagnoses, along with the addition of certain new diagnostic categories, could lead to inappropriate diagnosis and treatment with potentially iatrogenic medications in vulnerable populations such as young children, adolescents, and older adults. The video encouraged viewers to access the open letter petition website and if they agreed with the concerns expressed in the open letter, to sign the petition, which is available at https://www.ipetitions.com/petition/dsm5. (The “Open Letter” petition can still be signed. If you have not already done so, we encourage you to read the “Open Letter” and, if you agree with it, to sign the petition.)
New letters from other organizations and societies soon followed. In November 2011, Don Locke, then the President of the American Counseling Association (ACA), sent a letter on behalf of the ACA to American Psychiatric Association President John Oldham expressing concerns about the quality and credibility of DSM-5 and calling for an independent scientific review (Locke, 2011). In addition, the Association of Black Psychologists DSM-5 letter: http://www.abpsi.org/pdf/DSM5Commentary.pdf released a letter supporting the efforts of Coalition for DSM-5 Reform and outlining proposed changes that were particularly concerning due to the potential impact on the welfare of African Americans and people of African descent (Association of Black Psychologists, 2012).
We are happy to report that the number of endorsers of the “Open Letter” has now grown to more than 15,000 individuals and more than 50 mental health groups and organizations (see Table 1 for a list of organizations that signed the petition). We owe a debt of gratitude to Allen Frances, MD, who had chaired the DSM-IV Task Force and who had been raising concerns about the proposed DSM-5 for some time (e.g., Frances, 2009a, 2009b, 2009bc, 2009d, 2010a, 2010b). Dr. Frances assisted us greatly by publishing our Open Letter and petition website link in his popular blogs (e.g., Frances, 2011a, 2011c). The Division 32 “Open Letter,” which appears as the last article in this special issue, focused on the following major concerns about the proposed DSM-5: the lowering of diagnostic thresholds, increasing the number of people who qualify for a diagnosis and potentially leading to overmedicalization and stigmatization of normative distress; proposed disorder categories that risked misuse in vulnerable populations, including children (e.g., “disruptive mood dysregulation disorder” and “attenuated psychosis syndrome”) and the elderly (e.g., “mild neurocognitive disorder”); proposals that seemed to pose the risk of labeling sociopolitical deviance as mental disorder; revisions to existing disorder groupings that appeared to be unsubstantiated; and a new overarching emphasis on medicophysiological theory. The “Open Letter” expressed particular concern with the paucity of empirical support for the above proposals.
Organizations Endorsing the “Open Letter to DSM-5.”
The DSM-5 Task Force and the American Psychiatric Association responded to the “Open Letter” (DSM-5 Task Force Members, 2011) and thanked us for it. They assured us that they would consider the concerns that had been raised. In November 2011, the Division 32 Open Letter Committee responded to the DSM-5 Task Force (Elkins et al., 2011), thanking them for their letter and highlighting some of our continuing concerns. Then, in January 2012, the Open Letter Committee sent a second letter to the DSM-5 Task Force and the American Psychiatric Association (Elkins, Farley, Raskin, Robbins, & Rockwell, 2012), which requested that the controversial proposals in DSM-5 be submitted for an outside, independent review by scientists and scholars who had no associations with the DSM-5 Task Force or the American Psychiatric Association. The then President of the American Psychiatric Association responded in a letter to President Elkins (Oldham, 2012) refusing the request for an independent review, stating that there was no outside group of scholars and scientists who were qualified to evaluate the DSM-5 proposals.
In 2012, after the public posting of the final DSM-5 draft proposals online, the Open Letter Committee posted a new letter to the DSM-5 Task Force and the American Psychiatric Association (DSM-5 Open Letter Committee, 2012). The new letter expressed appreciation for changes to the manual that seemed in accord with some of the expressed concerns made in the original “Open Letter,” and it also stated continuing concerns about the proposed manual and its development process. More specifically, the new letter expressed appreciation for the relegation of attenuated psychosis syndrome and mixed anxiety–depression, two proposed disorders with insufficient empirical support, to the research appendix. It also expressed appreciation for the deletion of the phrase “underlying psychobiological dysfunction” from the new definition of mental disorder. The new letter also expressed continuing concern about the following:
The proposal to include new disorders with relatively little empirical support and/or research literature that is relatively recent (e.g., “disruptive mood dysregulation disorder”).
The lowering of diagnostic thresholds, which may result in diagnostic expansion and various iatrogenic hazards, such as inappropriate treatment and stigmatization of normative life processes. Examples include the newly proposed “minor neurocognitive disorder,” as well as proposed changes to generalized anxiety disorder, attention deficit/hyperactivity disorder, pedophilia, and the proposed behavioral addictions.
The perplexing personality disorders overhaul, which was viewed by many experts as an unnecessarily complex and idiosyncratic system that was likely to have little clinical utility in everyday practice.
The development of novel scales (e.g., severity scales) with little psychometric testing.
In addition, the Open Letter Committee expressed concerns about the development process of the manual:
Continuing delays, particularly in the drafting and field testing of proposals (e.g., Frances, 2012b).
The substandard results of the first set of field trials, which revealed kappas below accepted reliability standards (see Dayle, 2012).
The cancellation of the second set of field trials (see Dayle, 2012).
The lack of formal forensic review (see American Psychiatric Association, n.d.).
Ad hominem responses to critics (e.g., Schatzberg, Scully, Kupfer, & Reiger, 2009a).
The hiring of a PR form to influence the interpretation and dissemination of information about DSM-5, which is not standard scientific practice (Chapman, 2012; Frances, 2012a).
Finally, we requested, for the second time, that the controversial proposals in the DSM-5 be submitted for an outside, independent review.
New Members and APA Conventions
As the Open Letter Committee began to engage more frequently with the media, Elkins appointed Donna Rockwell to join the committee. Dr. Rockwell was able to bring her background as a CNN journalist and reporter to help the committee communicate more effectively with the public about the problems of the DSM-5 proposals. Elkins also appointed past APA president Frank Farley and Jon Raskin to the committee.
At the APA Annual Convention in Orlando, Florida (August 2-5, 2012), Division 32 sponsored a 2-hour symposium, along with conversation hours, dedicated to the DSM-5 reform effort. The symposium, which attracted more than 400 people, was chaired by Robbins (who also presented) and had the following other participants: Dayle Jones of the University of Central Florida, a major architect of the ACA’s response to the DSM-5 Task Force; Sarah Kamens, doctoral candidate in clinical psychology at Fordham University; Lisa Cosgrove of the University of Massachusetts; Douglas Bremner, a psychiatrist from Emory University; and David Elkins of Pepperdine University. The audience was enthusiastic and clearly committed to the DSM-5 reform effort. At a conversation hour on Saturday at the convention, the speakers included Melba Vasquez, immediate past president of the APA; Frank Farley, past president of both Division 32 and the APA; Peter Kinderman, primary architect of the BPS’s response to the DSM; Donna Rockwell of Michigan School of Professional Psychology and a former CNN reporter; Jonathan Raskin of State University of New York at New Paltz and an influential constructivist psychologist; and several presidents and appointees of APA divisions who gave brief comments on why their divisions endorsed the “Open Letter” and joined the DSM-5 reform effort. During the audience participation portion of the conversation hour, members of the audience made insightful and passionate comments in favor of the reform effort. In short, the symposium and conversation hours at the APA convention in Orlando were memorable in terms of attendance, passion, and commitment of both the speakers and the audience.
Since 2012, Division 32 has continued to sponsor and organize annual programming on the DSM-5 and alternatives to DSM diagnosis at the annual APA conventions. These events in general have generated sizeable audiences. In March of 2013, Robbins, Rockwell, and Kamens presented a symposium at the Division 32 conference, held at Pacifica Graduate Institute at Carpinteria, CA. Titled “Preparing for the SHP-Initiated 1st Annual Summit on Diagnostic Alternatives,” the presentation outlined our plans to organize an international group of scholars to meet and discuss alternatives to DSM diagnosis. At the 2013 APA convention in Hawaii, Robbins chaired a cross-divisional symposium on the DSM-5 and the future of mental health diagnosis, which included Joshua W. Clegg, Nancy N. Williams, Philip Cushman, Peter Kinderman, and Joan C. Chrisler. The symposium involved the collaborative efforts of five divisions of APA: Society for Theoretical and Philosophical Psychology (Division 24), Society for the History of Psychology (Division 26), SHP (Division 32), Society for the Psychology of Women (Division 35), and Psychoanalysis (Division 39). The event was attended by over 500 people.
Brent Robbins became President-Elect of Division 32 in 2013, and initiated a two-pronged approach in order to respond to the newly published DSM-5. As the manual had already been published, and most of our recommendations were ignored, it was time for a new phase of the project. Two separate committees were formed, one focused on ongoing reform of the DSM-5, the DSM-5 Reform Committee, and a second which was focused on planning an international diagnostic summit that would discuss alternatives to the DSM-5. The latter committee was called the International Diagnostic Summit Committee. Robbins and Peter Kinderman cochaired the Future of Mental Health Diagnosis Task Force that housed the two committees. A subcommittee, on the International Diagnostic Summit, was cochaired by Jonathan Raskin and Frank Farley. Jason McCarty, a Canadian psychologist, was extraordinarily helpful in developing and managing websites for these projects. In addition, the River Styx Foundation provided a generous $30,000 grant to Division 32 for the DSM-5 reform effort, which allowed the Division to hire a talented public relations manager, Chloe Detrick. Detrick helped manage the website and organize an International Diagnostic Summit in Washington, D.C., in August of 2014.
The Global Summit on Diagnostic Alternatives
Initially, the Global Summit on Diagnostic Alternatives (GSDA) was an online venture, which is archived at dxsummit.org. A joint venture of APA Division 32 and the BPS Division of Clinical Psychology, the Internet-based platform was used for open discussion about alternatives to the current diagnostic paradigm. GSDA was intended to function as a central hub for discourse on psychiatric diagnosis in all its implications and forms: scientific, theoretical, clinical, practice, ethical, social, and political. Rather than starting from a specific theory about the “right” way to define and treat psychological suffering, GSDA was a virtual arena for the expression of diverse perspectives, a space to deliberate about those questions that seem most challenging and, at times, insurmountable. Our ultimate goal was to generate transdisciplinary, international, egalitarian conversation about the possibility, feasibility, and potential implications of new means for conceptualizing mental distress.
GSDA’s mission statement, written by Kamens et al. (2013) read as follows:
Something new is happening in the world of mental health. In recent years, professionals from across the varied mental health disciplines—psychiatrists, clinical psychologists, social workers, counselors, marriage and family therapists, and others— have begun to ask questions about some of the basic assumptions that form the very foundation of our work. At the heart of these questions is a growing doubt about the official diagnostic systems for mental disorder.
The DSM and the International Classification of Diseases (ICD) are the two official diagnostic systems currently in use in the United States and abroad. Since the late 1970s, these parallel manuals have loosely followed the “neo-Kraepelinian” system, a categorical diagnostic paradigm containing criterion-based descriptions of mental disorders and their corresponding symptoms. The neo-Kraepelinian approach was expected to elevate psychiatric diagnosis to the standards of general medicine, and after its introduction, diagnosis became increasingly central to clinical research and practice. Today, researchers and practitioners across the globe use the DSM and ICD on a daily basis to understand and communicate about the mental distress reported by their patients, clients, and research participants. Over the past three decades, mental health practice has become virtually synonymous with the diagnosis of mental disorder.
Yet in recent years, clinicians and researchers have started to question the very diagnostic paradigm that once gave them so much hope. Mounting scientific evidence has indicated that DSM- and ICD-based categories do not reflect patterns of mental distress found in both clinical and general populations. The genetic and biological substrates of mental disorder appear to be multifactorial and nonspecific, with varied correlates appearing within and across multiple disorder categories. Furthermore, reports from clinicians indicate that patients are often labeled with conditions they do not seem to have, simply for the purpose of securing treatment. Growing uncertainty about the validity of the DSM and ICD systems came to a fore in recent years, as psychiatric taxonomists sought to revise the manuals in line with current research. As the revisions are underway, heated debates about the current approach to diagnosis—and, by extension, the very nature of psychopathology—have appeared throughout the clinical and research literature.
Growing consensus now holds that, though the upcoming iterations of DSM (now in its 5th edition) and ICD (approaching its 11th edition) will not depart significantly from the familiar paradigm, future diagnostic models may require revolutionary change. Chair of the DSM-IV Task Force Allen Frances (2011b) has suggested that “[t]oday’s psychiatric labels will one day seem [ . . . ] quaint” (para. 8). Similarly, DSM-5 architects have lamented that “The DSM-III categorical diagnoses with operational criteria were a major advance for our field, but they are now holding us back because the system has not kept up with current thinking” (Schatzberg, Scully, Kupfer, & Regier, 2009b, para. 7). As a result of new and widespread disillusionment with the current system, contemporary discourse in psychiatry and related clinical disciplines is characterized by multiplicity, polyvocality, and frequent discord. Proposals to reconceptualize and redefine clinical diagnosis have emerged from all corners of the mental health world, including biogenetic and behavioral psychiatry (e.g., RDoC; National Institute of Mental Health, 2012), psychoanalysis (e.g., PDM Task Force, 2006), and personality psychology (e.g., Krueger & Markon, 2006). Though psychopathologists have yet to establish the diagnostic paradigm of the future, most agree with the oft-cited prognostication that
we are at the epicycle stage of psychiatry where astronomy was before Copernicus and biology before Darwin. Our inelegant and complex current descriptive system will undoubtedly be replaced by explanatory knowledge that ties together the loose ends. Disparate observations will crystallise into simpler, more elegant models that will enable us not only to understand psychiatric illness more fully but also to alleviate the suffering of our patients more effectively. (Frances & Egger, 1999, p. 165)
Gathering of the GSDA in Washington, DC
In recognition of the need for a new means of defining and classifying mental distress, the Diagnostic Summit Committee of the Society for Humanistic Psychology has established the GSDA, an Internet-based platform for open discussion about alternatives to the current diagnostic paradigm. We are a multidisciplinary group of researchers and practitioners who are concerned with the future of mental health, but disappointed by the lack of free and open dialogue about the issues that matter most. GSDA is intended to function as a central hub for discourse on psychiatric diagnosis in all of its implications and forms: scientific, theoretical, clinical, practical, ethical, social, and political. Rather than starting from a specific theory about the “right” way to define and treat psychological suffering, GSDA is a virtual arena for the expression of diverse perspectives, a space to deliberate those questions that seem most challenging and, at times, insurmountable. Our ultimate goal is to generate a transdisciplinary, international, egalitarian conversation about the possibility, feasibility, and potential implications of new means for conceptualizing mental distress.
Among the questions we will discuss are
What is the basic nature and function of clinical diagnosis?
Is diagnosis necessary for describing mental distress?
To what extent should psychiatric diagnosis mirror diagnosis in general medicine, and why?
What is the current status of diagnosis across the helping professions?
Why have mental health professionals become disillusioned with the current diagnostic systems for research and practice?
What function does diagnosis have for patients/clients?
What are the iatrogenic risks of clinical diagnosis?
How do diagnoses function in larger society and the public sphere?
Is diagnosis a universal phenomenon? Can diagnostic practice be generalized across cultures?
How can the major helping professions work together to address current issues in diagnosis?
What do the various helping professions see as the most important dilemmas its practitioners face regarding diagnosis and what ideas do these professions have regarding directions for diagnosis in the future?
What are possible alternatives to the DSM/ICD systems?
Are these alternatives feasible/practical?
What are the political and ethical implications?
Should we prioritize validity over utility, or vice versa?
Should interdisciplinary scholars (in the neighboring social sciences and humanities) be involved in the development of diagnostic alternatives?
GSDA will start with a series of invited blogs and expand, according to need, into a multimedia platform for texts, videos, and discussion forums. We will seek the participation of individual experts in the area of diagnosis as well as major mental health organizations from around the globe. Interdisciplinary academics from the broader social sciences, medical humanities, and natural sciences will also be invited to participate.
We recognize that there are multiple and often competing perspectives on diagnosis in the contemporary world of mental health. We believe that these differences are not a stumbling block, but rather a starting place for real dialogue about the possibility for change. With GSDA, we hope to open a new and centralized space for this dialogue by gathering all those invested in the future of diagnosis—scientists and practitioners, “lumpers” and “splitters,” dreamers and skeptics—under one virtual roof.
GSDA Committee
The GSDA Committee members included the following experts:
Tim Carey: Professor in Mental Health, Flinders University, Australia
Anne Cooke: Principal Lecturer in Applied Psychology, Canterbury Christ Church University, UK
Lisa Cosgrove: Associate Professor of Counseling and School Psychology, University of Massachusetts at Boston, USA
Chloe Detrick: Research Assistant, SHP, USA
Barry Duncan: Psychotherapist, Trainer, and Researcher, USA
Frank Farley: L. H. Carnell Professor, Temple University, Former President of APA, USA
Harris Friedman: Professor Emeritus, Saybrook University, USA
Louis Hoffman: Professor of Clinical Psychology, Saybrook University, USA
Lois Holzman: East Side Institute, USA
Lucy Johnstone: Clinical Psychologist, Bristol, UK
Sarah Kamens: Doctoral Candidate in Clinical Psychology, Fordham University, USA
Peter Kinderman: Professor of Clinical Psychology, University of Liverpool, UK
V. Krishna Kumar: Professor of Psychology, West Chester University, USA
Eleanor Longden: Research Psychologist, UK
Eric Maisel: Family Therapist, USA
Richard Pemberton: Chair, British Psychological Society Division of Clinical Psychology, UK
Jonathan D. Raskin: Professor of Psychology and Counseling, State University of New York at New Paltz, USA
Brent Dean Robbins: Associate Professor of psychology, Point Park University, USA
Donna Rockwell: Michigan School of Professional Psychology, USA
Jeffrey Rubin: Licensed Psychologist, USA
Shawn Rubin: Professor of Clinical Psychology, Saybrook University, USA
Kirk J. Schneider: Licensed Psychologist, USA
Sarah Schulz: Assistant Professor of Behavioral Science, Point Park University, USA
In addition, consultants of the Committee included the following:
Richard Bentall: Professor of Clinical Psychology, University of Liverpool, UK
Mary Boyle: Professor Emeritus of Clinical Psychology, University of East London, UK
Pat Bracken: Consultant Psychiatrist and Clinical Director of Mental Health Services, West Cork, Ireland
Joanne Cacciatore: Assistant Professor, Arizona State University School of Social Work, USA
David Castle: Professor of Psychiatry, University of Melbourne, Australia
Jack Carney: Licensed Clinical Social Worker, Brooklyn, New York, USA
Jacqui Dillon: Chair, Hearing Voices Network, UK
Suman Fernando: Honorary Professor in the Faculty of Social Sciences and Humanities, London Metropolitan University, former Consultant Psychiatrist, UK
Daniel Fisher: Consultant Psychiatrist, National Empowerment Centre, USA
Dave Harper: Reader in Clinical Psychology, University of East London, UK
Dayle Jones: Associate Professor, University of Central Florida, USA
Patrick Landman: Psychiatrist and Psychoanalyst, Paris, France
Eleanor Longden: Psychologist, London, UK
Steve Majerus: Department of Psychology: Cognition and Behavior, University of Liège, Belgium
Jason McCarty: Psychotherapist, British Columbia, Canada
Nancy McWilliams: Psychologist and Psychoanalyst, Rutgers University, USA
Gordon Milson: Clinical Psychologist, Manchester, UK
Sharna Olfman: Professor of Psychology, Point Park University, USA
Bradley Olsen: President-Elect, Division 48 of APA; President, Psychologists for Social Responsibility, Chicago, USA
Ana Padilla: University College London, UK
Dave Pilgrim: Professor of Health and Social Policy, University of Liverpool, UK
John Read: Professor of Clinical Psychology, University of Auckland, New Zealand
Melissa Raven: Research Fellow, Flinders University, Australia
Dave Traxson: Educational Psychologist, UK
Sara Tai: Senior Lecturer in Clinical Psychology, University of Manchester, UK
Phil Thomas: Honorary Visiting Professor, University of Bradford, Former Consultant Psychiatrist, UK
Sam Thompson: University of East London, UK
Sami Timimi: Consultant Psychiatrist, UK
Steve Trenchard: Chair, International Society for Psychological and Social Approaches to Psychosis, UK
Martin Whitely: Parliament of Western Australia, Australia
The GSDA online platform became the launching ground for an in-person International Summit on Diagnostic Alternatives, which was held in Washington, D.C., in August, 2014, just prior to the APA Convention that year. All of the committee members listed above were in attendance. The meeting lasted for 2 days, and included lengthy discussion about possibilities for moving forward with potential alternatives to the DSM and ICD systems. There was a general consensus that although criticism of the current diagnostic paradigm has its place, from this point forward, we also needed to focus our energies on the question of how to develop a legitimate alternative.
Aaron T. Beck was also a guest at the Summit, and participated by speaker phone. Beck expressed solidarity with the GSDA project, and noted that his approach to psychosis, in particular, had been taking an increasingly “humanistic” turn—a nod to Society SHP’s role in leading the charge. Beck’s ideas about working with psychosis are closer to those of R. D. Laing (1965) and Loren Mosher, Hendrix, and Fort (2004) than to the medical model approach commonly seen today. Beck’s sentiments, as a living legend in the field of psychology, buoyed the spirits of the group, who pressed on with a full agenda.
By the end of the in-person summit, the GSDA Committee established four different working groups, which were charged with continuation of the GSDA mission. Rather than engaging in dialogues on the GSDA website, these working groups communicated primarily by e-mail to accomplish their goals. The four working groups included the following.
Standards/Guidelines Working Group
Charge: To generate a set of scientific and ethical standards/guidelines for the development of diagnostic and descriptive nomenclatures for mental distress; the standards are intended to represent “best practice” in classification and description, and in this way, will be applicable to both the current/mainstream diagnostic models and to any present or future alternative.
Members: Lisa Cosgrove, Barry Duncan, Sarah Kamens (Chair), Eleanor Longden, Sarah Schulz.
Outreach Working Group
Charge: Networking and promotion; outreach to public; outreach to media, publications, and community.
Members: Tim Carey, Frank Farley, Harris Friedman, Louis Hoffman, Lois Holzman, Peter Kinderman, Donna Rockwell (Chair), Shawn Rubin, Sarah Schulz.
Identifying Alternatives Working Group
Charge: To examine dimensions/axes of relevance in any viable alternative, to develop descriptive ways of identifying problems or concerns, and to propose other possibilities for diagnostic alternatives.
Members: Frank Farley, Lucy Johnstone, V. Krishna Kumar, Eric Maisel, Jonathan Raskin, Brent Dean Robbins, Jeffrey Rubin (Chair), Kirk Schneider.
Summit II Planning Working Group
Charge: To develop plans and seek funding for the next summit, to be held in Spring/Summer 2015.
Members: Brent Dean Robbins, Sarah Kamens, Shawn Rubin, Peter Kinderman, Richard Pemberton (Chair).
Ultimately, the planning for an in-person Summit II did not come to fruition due to limited resources. The committees decided, instead, to move forward with a special issue of an academic journal, culminating in individual scholarly papers that are being published in this special issue of Journal of Humanistic Psychology, as well as several additional special issues that will appear subsequent to this one. Among them, to appear in one of the later special issues, the product of the Standards/Guidelines group will be an article which outlines the findings of the group. The development of alternatives to current diagnosis have also culminated in essays that will appear in this issue and subsequent Journal of Humanistic Psychology special issues on diagnostic alternatives.
At the APA Convention in August of 2014, Division 32 sponsored two symposiums which communicated findings related to the International Diagnostic Summit. The panel, “Beyond Psychiatric Diagnosis: Critiques and Alternatives from U.K. Clinical Psychologists,” was chaired by Brent Robbins and featured U.K. psychologists who were involved with GSDA. Richard Pemberton presented on the U.K. Division of Clinical Psychology’s Position Statement on Classification, and discussed the implications for theory and practice. Lucy Johnstone gave an overview of the key principles of the U.S. Division of Clinical Psychology’s Good Practice Guidelines on the Use of Psychological Formulation. Anne Cooke outlined a psychosocial approach to understanding psychosis, and Eleanor Longden discussed her own personal experience of psychosis and touched upon the themes of “Recovery, Discovery, and Transformation.”
The symposium, “DSM-5: Problems, Solutions, and Alternatives” featured U.S. perspectives, and was also chaired by Robbins. Robbins gave a paper on “Dignity, Diagnosis and Social Justice,” which introduced an ethics of dignity as a basis for understanding stigma associated with mental illness. Jonathan Raskin and Michael C. Gayle presented survey research findings demonstrating general dissatisfaction with the DSM-5 among psychologists. Their findings also demonstrated that psychologists do, in fact, desire an alternative to DSM diagnosis. Lisa Cosgrove outlined conflicts of interest in the publication of DSM-5, related to its use as a vehicle for high-profit patent extensions. Finally, Peter Kinderman presented a vision of a way forward beyond the medical model of diagnosis toward an alternative, psychological model.
In 2015, again at the APA Convention, Sarah Kamens and Jonathan Raskin cochaired a symposium, “Beyond the DSM: Current Trends in Devising New Diagnostic Alternatives.” The panel presented diagnostic alternatives that were being pursued by those involved in the GSDA. Lois Holzman began by reviewing community voices of diagnosis. She discussed the importance of psychologists listening to the wider community as they develop diagnostic alternatives. Kirk Schneider discussed a proposed alternative to DSM diagnosis which he described in terms of “the polarized mind,” the fixation on a single point of view to the exclusion of competing points of view. Barry Duncan discussed the Partners for Change Outcome Management System as an alternative to medical model diagnosis. Jeffrey Rubin outlined the vision of The Classification and Statistical Manual of Mental Health Concerns as a model for an alternative to DSM. Finally, Raskin presented the need to build a diagnostic alternative more suitable for psychotherapists. Later, at the Division 32 Hospitality Suite, Sarah Kamens and Brent Robbins outlined what would become the “Standards and Guidelines for the Development of Diagnostic Nomenclatures and Alternatives to Mental Health Research and Practice,” which will be featured in an upcoming special issue.
At the 2016 APA Convention, David Elkins chaired the panel, “Rethinking the Medical Model—Beyond Diagnosis, Drugs and Deficits.” Brent Robbins presented a paper, coauthored by Justin Kartner and Kevin Gallagher, “Big Pharma(kos): The Stigmatized Scapegoat of Medicalization and the Ethics of Psychiatric Diagnosis,” which described how diagnosis can and is often used as a scapegoat mechanism, and the social justice implications of this model. Barry Duncan described Partners for Change Outcome Management System as a relational rather than a medical model of diagnosis. Sarah Kamens presented a phenomenological study, “Reconceptualizing the Schizophrenia Diagnsis: A Transcultural, Phenomenological Investigation.”
Another, larger symposium at the 2016 APA Convention was titled “The Future of Diagnosis—Ethics, Social Justice, and Alternative Paradigms,” and was cochaired by Brent Robbins and Sarah Kamens. Lisa Cosgrove discussed the influence of the pharmaceutical industry on new DSM-5 diagnoses. Anthony Pavlo presented on diagnostic practice from a recovery-oriented and person-centered perspective. Sarah Kamens introduced the “Standards and Guidelines for the Development of Diagnostic Nomenclatures and Diagnostic Alternatives.” Jeffrey Rubin discussed The Classification and Statistical Manual of Mental Health Concerns as a person-centered, culturally sensitive, recovery-oriented alternative to the DSM and ICD. Finally, Peter Kinderman discussed the role of science in the development of alternatives to diagnosis in clinical practice. Donna Rockwell was discussant, and tied the themes of the panel together through the theme of mindfulness.
Conclusion
This article has provided a historical overview of SHP’s efforts to reform the DSM over the past 5 years. Perhaps the greatest lesson to be drawn from this history is that when thousands of mental health professionals and dozens of psychology organizations join forces and work together, they can have a significant impact on major issues facing our profession. This special series in the Journal of Humanistic Psychology is part of this ongoing and collaborative effort to bring about change in how our profession views and classifies psychological difficulties. We hope this article, along with the other articles in this special series, will inspire others to become involved in this important effort.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.