Global Summit on Diagnostic Alternatives

Our Mission: To develop, evaluate, advocate, and disseminate alternatives to current diagnostic systems.

dxsummit

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 Diagnostic and Statistical Manual of Mental Disorders (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. Further, 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 (entering its fifth 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 (2011) 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, 2009, 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; NIMH, 2012), psychoanalysis (e.g., PDM Task Force, 2006), and personality psychology (e.g., Krueger & Eaton, 2010). 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)

The Global Summit on Diagnostic Alternatives (GSDA)

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 Global Summit on Diagnostic Alternatives (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/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.

References

Frances, A. (2011). Why psychiatrists should mind their language. Culture Lab. Retrieved 15 December, 2011 from http://www.newscientist.com/blogs/culturelab/2011/12/why-psychiatrists-should-mind-their-language.html

Frances, A. J., & Egger, H. L. (1999). Whither psychiatric diagnosis. The Australian and New Zealand Journal of Psychiatry, 33(2), 161-165.

Krueger, R. F., & Eaton, N. R. (2010). Personality traits and the classification of mental disorders: Toward a more complete integration in DSM–5 and an empirical model of psychopathology. Personality Disorders: Theory, Research, and Practice, 1, 97-118.

National Institute of Mental Health (NIMH). (2012). Research Domain Criteria (RDoC). Retrieved from http://www.nimh.nih.gov/research-funding/rdoc/index.shtml

PDM Task Force. (2006). Psychodynamic diagnostic manual. Silver Spring, MD: Alliance of Psychoanalytic Organizations.

Schatzberg, A. F., Scully, J. H., Kupfer, D. J., & Regier, D. A. (2009). Setting the record straight: A response to Frances commentary on DSM-V. Psychiatric Times, 26. Retrieved from http://www.psychiatrictimes.com/dsm/content/article/10168/1425806