Introduction to the Fourth Special Issue on Diagnostic Alternatives

Abstract

We are pleased to introduce the fourth issue in the Journal of Humanistic Psychology Special Issue Series on Diagnostic Alternatives. Diagnostic alternatives can be defined as approaches or frameworks that might serve as alternatives to the conventional diagnostic model represented by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013) and the mental and behavioral disorders section of the International Classification of Diseases (ICD; World Health Organization, 1992a, 1992b). Some alternatives are improvements to the current paradigm; others propose new diagnostic models or nondiagnostic approaches. Our overarching introduction to the special-issue series can be found in the first special issue (Kamens, Robbins, & Flanagan, 2017). The second and third issues in the series (Kamens, Flanagan, & Robbins, 2018; Kamens, Robbins, & Flanagan, 2019) focused on specific alternatives and the diverse meanings of diagnosis, respectively.

The fourth and present special issue is dedicated to three articles that present broader principles, foundations, guidelines, and standards for the development of diagnostic paradigms and alternative models. These articles offer meta-theoretical, ethical, and scientific frameworks for the development of broad paradigms and specific approaches for the description and/or classification of psychological distress. Each article in this issue is followed by three commentaries that explore diverse perspectives on its principles and proposals.

The first article, written by Anthony Pavlo, Elizabeth Flanagan, Larry Leitner, and Larry Davidson, poses the question: “Can there be a recovery-oriented diagnostic practice?” Pavlo and colleagues suggest that recovery-oriented diagnostic possibilities are grounded in collaboration, dialogue, agency, hope, relevancy, and a focus on both the strengths and the meanings of psychological pain. In the first commentary, “Label jars not people,” Ronald Bassman memorably describes Pavlo and colleagues’ recovery-oriented principles as a humanistic alternative to “the Procrustean bed we loosely call Mental Health.” Next is a commentary by Golan Shahar, who contemplates recovery-oriented models in the context of his views on the present and future of psychiatry. In the third commentary on Pavlo and colleagues’ article, Aieyat Zalzala, Emily Gagen, and Paul Lysaker outline specific strengths and challenges of recovery-oriented formulations for persons diagnosed with serious mental illnesses.

“What might an alternative to the DSM suitable for psychotherapists look like?” This is the question posed by Jonathan Raskin, author of the second article in this issue. Raskin explains that a fitting alternative to the DSM would need to include psychosocial factors, focus on problems instead of people, emerge from collaborative development, be scientifically grounded, and be utilizable by multidisciplinary professionals. The first commentary on Raskin’s article, authored by Rachel Cooper, reflects the common desire for alternatives among psychotherapists and explores systemic obstacles in third-party payment mechanisms. In the second commentary, Jay Efran and Jonah Cohen outline sociolinguistic challenges in the development of a truly biopsychosocial approach. The last commentary on this article, written by Tom Strong, reflects on the importance of Raskin’s concerns about systematization and reification from a relational perspective.

The third article in the present issue is the “Standards and guidelines for the development of diagnostic nomenclatures and alternatives in mental health research and practice” by Kamens et al. Developed by a diverse and multidisciplinary team, these standards and guidelines offer a series of scientific and ethical considerations for the development and revision of both diagnostic nomenclatures and alternative systems. In commenting on the standards and guidelines, Jazmine Russell of the Institute for the Development of Human Arts reflects on the psychological and ethical implications of common versus pluralistic languages for describing mental distress. Next, Peter Zachar proposes that a pragmatic approach to aspirational aspects of the Standards and Guidelines might be most fitting for their public policy implications. Finally, Jared Keeley considers the ways in which the Standards and Guidelines offer a mechanism for identifying the social processes inherent in all diagnostic systems and alternatives.

The articles and accompanying commentaries in this special issue represent the forefront in contemporary humanistic thinking about the ethical, scientific, and conceptual frameworks of diagnosis and future diagnostic alternatives. In offering person-centered principles for the development of alternatives, these articles reflect the importance of remembering, considering, and regularly revisiting not only the psychosocial and broader societal implications, but also the social grounding of any given diagnostic system or alternative—in other words, the ways in which mental health discourse contributes to social constructs and ontologies. Put differently, clinical paradigms, albeit often born in laboratories, both shape and are shaped by the real-world contexts in which they operate. Yet there is little understanding of how to enhance the benefits and minimize potential harms to these real-world contexts and the people dwelling within them. For these reasons, the articles in this special issue are intended to serve as ongoing resources for the development, revision, and implementation of diagnostic systems and alternatives in the present and future.

Footnotes

Author Biographies

Sarah R. Kamens, PhD, is currently a postdoctoral fellow in Psychology at Wesleyan University. She completed her predoctoral and postdoctoral clinical training at the Yale University School of Medicine. She holds a PhD in clinical psychology from Fordham University and an MA in Communication from the division of Philosophy, Art & Critical Thought at the European Graduate School. Her interdisciplinary research focuses on diagnostic theory, the phenomenology of “psychosis,” and sociopolitical marginalization. She is currently a Member-at-Large on the Society for Humanistic Psychology (APA Division 32) Executive Board and a member of the editorial boards for The Humanistic Psychologist and the Journal of Humanistic Psychology.

Elizabeth H. Flanagan, PhD, is an assistant professor in the Yale Program for Recovery and Community Health, Department of Psychiatry, at the Yale School of Medicine. She has been researching and writing about diagnosis and the Diagnostic and Statistical Manual of Mental Disorders (DSM) for the past 20 years. Recent research has focused on the subjective experience of mental illness and the validity of the DSM. She argues that the validity of the DSM could be improved if the DSM development process included people with lived experience in important roles in diagnosis development workgroups and if diagnostic categories became more aligned with the experience of mental illness rather than how they appear to clinicians. Past research focused on clinicians’ natural taxonomies that develop as a result of clinical experience and the relationship between these taxonomies and the DSM.

Brent Dean Robbins, PhD, is chair of the Department of Psychology and associate professor at Point Park University in Pittsburgh, Pennsylvania, where he led the development of two humanistically oriented graduate programs (MA, PsyD) in clinical-community psychology. He has a doctorate in clinical psychology from Duquesne University. He has served as past president, council representative, secretary, and member-at-large within the Society for Humanistic Psychology (Division 32 of APA) and has been one of the primary organizers of the Society’s annual conference. He is a recipient of the Carmi Harari Early Career Award. He is the editor-in-chief of the interdisciplinary, international journal, Janus Head, and coeditor of Drugging Our Children: How Profiteers Are Pushing Antipsychotics on Our Youngest, and What We Can Do To Stop It (2013, Praeger).

References

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