Occupy Psychiatry: Amid DSM 5 Controversy, Movement Wants to Return to Freud
At first blush, this year's gathering of the American Psychiatric
Association had the air of a coronation. It kicked off at the George Moscone Center in San Francisco just as the dust was settling on Google's I/O 13, with a keynote by former president Bill Clinton and a grand unveiling of the newly revised Diagnostic Manual, now in its fifth edition. The conference theme -- "Pursuing Wellness Across the Lifespan' -- seemed both pedestrian and, as one commentator put it, boldly aspirational.
But the event wasn't without its detractors. On Sunday, a small crowd of people gathered outside Moscone Center, where conference attendees squeezed between a revolving carousel of tour buses, clutching their laminated name tags. They represented a loose consortium of organizations who'd all coalesced under the banner "Occupy Psychiatry" -- or, in this case, "Occupy the APA."
By poaching the language of current social movements, they sought to turn a debate over patient treatment into a class issue. They also hoped to give it sex appeal, and possibly draw in a much larger audience.
Granted, the issues these protesters embrace have little to do with many of the debates that have flared up around the new Diagnostic and Statistical Manual of Mental Disorders (the DSM 5), which includes a more generalized category for autism, plus new clinical terms for bad-tempered children (disruptive mood disregulation disorder) and senile geriatrics (mild neurocognitive disorder). While the Occupiers object to any overall plumping of an already-vast disorder taxonomy, they don't bother with small details. Instead, they want an overhaul of the diagnostic system at large, and a return to a more traditional form of psychoanalysis.
San Francisco psychotherapist Matthew Morrisey, who helped organize the rally, says that the current system serves the interests of pharmaceutical companies and medical providers rather than patients. "The DSM is just getting bigger and bigger," he said in an interview following the rally. "They keep adding diagnoses, and they become sort of inane at a certain point. They're just a tool to bill insurance companies."
Other DSM debunkers agreed, but they also found more fundamental problems with psychiatry -- like, the fact that it exists. Many suggest that by conflating diseases of the body with diseases of the mind, we've created a cold, clinical, dehumanizing, and largely unhelpful form of treatment -- one that lends itself to the nightmare scenarios that Ken Kesey dreamed up in One Flew Over the Cuckoo's Nest.
"If you believe that 40,000 lobotomies done in the US is appropriate, then you don't believe in human rights," said one speaker at the rally. Another equated modern psychiatry with "religious fundamentalist zeal."
Morrisey says he became disenchanted with current psychiatric mores back in 1995, when he was hospitalized for his first and only breakdown -- and treated like a second-class citizen, he says.
"They hammered me with anti-psychotics, Morrisey remembered. "They ended up putting this idea in my head that I was a broken human being with a possible genetic disorder."
He and others may have compelling anecdotal arguments, but they'll have a hard time gaining traction. If anything, the thrust of modern psychiatry is away from old-school Freudian analysis and toward a more clinical model that examines genetic risk factors and charts every disorder along a graph of biological symptoms. The list of new or newly modified disorders includes such everyday pathologies as internet and caffeine addiction.
This frustrates Morrisey and his ilk. "I'm not a trained analyst myself," he confessed, "but I see people once or twice a week and we talk about what's on their mind, and then we get into deeper issues. And they feel heard. And then they go out and do things in their real lives -- and all of a sudden they're getting better."
Yet even he'll admit the old Betty Draper couch-therapy school is slowly dying out. "Oh, we're like David and Goliath," he said, pointing out that the same grizzled crowd of therapists gathers outside the APA Conference when it graces San Francisco about once every decade, or so. Even with the added specter of the DSM 5 this year, the movement hadn't grown beyond a couple dozen picketers.
It may take more than an Occupy slogan to change that.