Modern Psychology is Kinda Shit

Psychology as we know it is largely based around one crucial but mildly questionable document - the DSM-V (Diagnostic and Statistical Manual of Mental Disorders). 

Frequently labeled as the “bible of psychiatry”, the DSM-V provides framework for diagnosing mental illnesses and disorders. It’s the very document which has brought us the diagnosable labels of ADHD, anxiety, depression, PTSD, BPD, and many, many more. 

The problem? Globally, experts and organisations in the field, (such as the American Journal of Psychiatry, the National Insititute of Mental Health, the British Psychological Society) have condemned the use of this document. The writer of the original edition (the DSM-III) literally prefaced the document warning against its use beyond a way to perceive clusters of symptoms – it was never intended to actually be used for forensic or insurance purposes. 

“Nonetheless it gradually became an instrument of enormous power: Insurance companies require a DSM diagnosis, and academic programs are organized around DSM diagnoses,” explains Dr. Bessel Van der Kolk, one of the world’s leading experts in trauma, in his book The Body Keeps the Score. “A psychiatric diagnosis has serious consequences: diagnosis informs treatment and getting the wrong treatment can have disastrous effects.” 

To this day, our mental health system fails thousands, giving the public countless misdiagnoses. 

Countless sources emphasize the profit the American Psychological Association (APA) - the producers of the DSM and its revised editions – make with each edition released, climbing up to hundreds of millions of dollars. 

Sarah Fay is a journalist and activist who received six misdiagnoses from the DSM. In an article for Mad in America, she critiques the upcoming release of the DSM-5-TR (Text Revised). The problem with mental health labels is once you get one, it tends to become a part of your identity. You start to notice any patterns of behaviour which match that label. 

Big pharmacy in America treats psychiatric drugs like any product on the market, the DSM makes this even messier. She tells a story of Vyvanse, an amphetamine that was brought to the market and sold as “the only drug available to treat [binge eating disorder]”, a diagnosis that came with the DSM-5. 

“Vyvanse became the official BED medication because there was a DSM diagnosis of BED. The FDA seemed not to mind that it hadn’t been proven as an effective treatment for binge eating disorder beyond its appetite-suppressing properties. A spokesperson for the Food and Drug Administration (FDA) said the drug was approved simply because there was no other medication to treat the newly minted binge eating disorder,” explains Fay. 

According to Fay, the introduction of this diagnosis would bring roughly $200-$300 million to the company, with 21 million new potential consumers. The psychiatric drug industry treats real people as consumers. Isn’t America meant to be in charge of the WAR on drugs, not the market for them? This whole system reduces drug users to either consumers or criminals. 

Dr Van der Kolk also paints this very problem with the DSM well, “Before the late nineteenth century doctors classified illnesses according to their surface manifestations, like fevers and pustules, which was not unreasonable, given that they had little else to go on. This changed when scientists like Louis Pasteur and Robert Koch discovered that many diseases were caused by bacteria that were invisible to the naked eye. Medicine then was transformed by its attempts to discover ways to get rid of these organisms rather than just treating the boils and the fevers they caused. With DSM-5 psychiatry firmly regressed to early-nineteenth-century medical practice. Despite the fact that we know the origin of many of the problems it identifies, its ‘diagnoses’ describe surface phenomena that completely ignore the underlying causes.” 

Regardless of the backlash that came with the latest edition of the DSM, the APA are still releasing yet another revised edition this month. The only difference is this time they’re keeping its release hushed and only available to those in the field. 

The APA describes the upcoming edition as “the most comprehensive, current, and critical resource for clinical practice available to today’s mental health clinicians and researchers,” but experts are skeptical.  

Dr. Stephen Ecks also condemns the DSM-5 in an article for the Canadian Medical Association Journal. Dr. Ecks quotes the British Psychological Association who blame the DSM-V for “the continued and continuous medicalisation of ... natural and normal responses.” 

The grief following the loss of a loved one (if lasting past a year) has been introduced as a diagnosis that can be medicated. 

Dr. Ecks draws on another quote from Psychology Today writer Allen Kuffel, who says that “turning bereavement into major depression would substitute a shallow, Johnny-come-lately medical ritual for the sacred mourning rites that have survived for millenniums”. 

President of the New Zealand Psychological Society Peter Coleman, and president-elect Kerry Gibson have also commented: 

“We, like many psychologists around the world, are concerned that the changes in the DSM are not supported by clear research evidence. As is generally recognised, DSM has always been a consensus document and in part reflects changes in social norms and beliefs (e.g. homosexuality was once listed as a mental disorder) as much as empirical research.” 

While the document isn’t required to be used in New Zealand, it’s enabled and frequently used by professionals across the country for diagnoses. With most fun things that come from America, the document is ridden with western rhetoric, really only addressing western ways of thinking. 

Hauora is the Te Ao Mа̄ori concept of wellbeing, it challenges how western institutes tend to treat mental illnesses (which is of course drugs and one-on-one therapy with a usually Pākehā professional), taking a far more holistic approach. 

Hauora focuses on four dimensions of well-being, taha tinana (physical), taha hinengaro (mental), taha whа̄nau (family and social) and taha wairua (spiritual). Identity is crucial to hauora, whereas medicine is primarily emphasized throughout the DSM. 

A study by Frontiers in Public Health explains that this “include[s] socio-economic factors, history, colonisation, structural, interpersonal or internalized discrimination, policy, changing demographics and media representation”, all of which of course was brought here with colonialism. 

Ginda Ryder, in a medically-reviewed article for PsychCentral explores the implications of the DSM’s diagnosis of schizophrenia for indigenous cultures. Ryder emphasizes the impacts of colonisation, indigenous worldviews, institutional racism and political marginalisation when dealing with mental health within indigenous cultures. Hauora covers these aspects where the DSM completely neglects to do so. Still, western approaches to mental health (including the DSM) are commonly employed when treating Mа̄ori patients. 

Schizophrenia among other diagnoses relies upon western systems, and “often distort the social and cultural realities of non-western populations,” explains Ryder. 

The article is careful not to group all indigenous populations together (to do so would be ignorant). But, of course, similarities are still found in the way this western thinking had caused issues for indigenous populations across the globe regarding mental health.  

Ryder quotes Jacqueline McPherson, Health Director of the Osoyoos Indian Band, a First Nations government operating in Canada. “Treating mental illness is as much about identity as it is about medicine.” 

The DSM focuses heavily on the individual, without taking other dimensions hauora considers.  

A Frontiers in Public Health study found that Mа̄ori youth tend to have poorer mental health than Pākehā youth. 

They also found that “a strong sense of Mа̄ori cultural identity was associated with improved well-being and reduced serious depressive symptoms”, but this in turn also led to higher rates of racial discrimination, which goes back to being associated with poorer mental health. 

The DSM, as a major influence on modern psychology, stupidly emphasizes medication and not a whole lot beyond that (aside from maybe a sprinkle of one-on-one therapy). 

A participant in a study regarding bipolar disorder amongst Mа̄ori and Aotearoa’s mental health services explains what she’s been through and seen. “I’m one of those fortunate people. I’ve had a lot of help, I’ve had a lot of people who have spent time. When I see tangata whaiora now, and I look at them, they seem so medicated, they’ve had their wairua taken off them. I’ve had the opposite. I’ve had people come in, always at a level which is to support and not to be a nuisance. I’ve had some really good psychiatrists that have given information, they’re kind of an open book. The psychiatrists that sit there with their questions and judgements, they are useless, but the others that are holistic, they are good.” 

“Participants were critical of care settings where the culture was dominated by westernized approaches, or Māori tikanga, kaupapa, values and practices were applied tokenistically rather than being a core consideration throughout,” the study found. 

“Unfortunately, participants described a tendency for health staff to fail to acknowledge or enquire about the cumulative impact on whānau of caring for a loved one with a chronic condition like [bipolar disorder].” 

Whа̄nau of a participant also shared their story. “By the time we knew what was wrong, she was well and truly unwell, and had to go to a mental health unit. The crisis team weren’t around. We didn’t know what to do. I got my local doctor, who we trusted. But he, like a lot of the professionals didn’t know what to do, and didn’t help. So, I learned what to look for. I found it happens really fast, extremely fast. That was the hardest thing to communicate to the professionals. That I knew she was unwell, but they’d wait until she was really bad.” 

We absolutely are in a time of change. More and more professionals are taking hauora into account, but we still need to do more. Research on Mа̄ori mental health is still relatively scarce, especially in comparison to more generalised studies of New Zealander’s mental health. The problem with that is that you can’t generalise Aotearoa’s culture, as we are a multi-cultural country. Outcomes of certain treatments need to be tailored to a patient, and this means going beyond performative applications. 

Aotearoa’s mental health sector no doubt needs a big ol’ revamp. While the DSM-V isn’t required to be used by professionals here, it doesn’t change the influence this document has. This document continues to cause harm to our already mentally fragile. To efficiently care for our mentally vulnerable and to honor Te Tiriti o Waitangi, we should really biff this document out altogether. This whole situation harms both marginalised groups and those living with mental illnesses, groups which voices aren’t as amplified as they should be. As a country we need to bring these issues into the spotlight, sit down, and listen when people are sharing the effects of our broken systems.