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The Spiritual Answer, Turn to The Lord Not Their Categories | KFP Articles
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Friday, 17 May 2013 22:18

The new edition of the DSM, Diagnostic and Statistical Manual of Mental Disorders, will be coming out soon and there's some very interesting dialogue on this manual and the very nature of psychiatric diagnosis.  Diagnosis for mental disorders is based on syndromal classifications.  Diagnosis is made based upon the association of several different factors such as signs, symptoms and phenomena.  A patient may have a certain set of symptoms and some characteristic traits that lead the physiatric clinician to a diagnosis.  This leads to a diagnosis without a strong physiological foundation.  It also leads to an unusual form of philosophical determinism.  The determinism of psychiatry, which is the belief that all phenomena can be explained by psychiatric causes, is to some degree based upon a set of criteria that is rooted in a philosophical psychology of the human person.  Or to put it more simply, since psychiatry can not explain the underlying causes of apparent disorders, it must theorize that there is some chemical imbalance causing the problem.  The role of spirituality and sin on the developing psyche has little relevance in this worldview.  There can be no spiritual causes but just a psychological affect related to spiritual practices.

The Director of the National Institute of Mental health has questioned the significance of the psychiatry profession's dependence on the D.S.M.:

While the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., is the best tool now available for clinicians treating patients and should not be tossed out, he said, it does not reflect the complexity of many disorders, and its way of categorizing mental illnesses should not guide research.

“As long as the research community takes the D.S.M. to be a bible, we’ll never make progress,” Dr. Insel said, adding, “People think that everything has to match D.S.M. criteria, but you know what? Biology never read that book.”

...The creators of the D.S.M. in the 1960s and ’70s “were real heroes at the time,” said Dr. Steven E. Hyman, a psychiatrist and neuroscientist at the Broad Institute and a former director at the National Institute of Mental Health. “They chose a model in which all psychiatric illnesses were represented as categories discontinuous with ‘normal.’ But this is totally wrong in a way they couldn’t have imagined. So in fact what they produced was an absolute scientific nightmare. Many people who get one diagnosis get five diagnoses, but they don’t have five diseases — they have one underlying condition.”

Dr. Hyman, Dr. Insel and other experts said they hoped that the science of psychiatry would follow the direction of cancer research, which is moving from classifying tumors by where they occur in the body to characterizing them by their genetic and molecular signatures.

This makes for a very interesting discussion from a clinical research perspective.  I'm glad to hear public discussion about this issue.  However, this problem raises another spiritual issue that I am most concerned with.  In an opinion piece at Wired, Allen Frances, the author of Saving Normal, addresses the relationship between the flaws of the D.S.M. manual as a means to diagnosis and the influence of Big Pharma, "With an assist from an overly ambitious psychiatry, all human difference is being transmuted into chemical imbalance meant to be treated with a handy pill. Turning difference into illness was among the great strokes of marketing genius accomplished in our time."  All too often, the differences that drive different personalities and gifts are being reduced to some disorder.  We have all seen cases of bi-polar, or some other mental illness, that are clearly clinical in their manifestation but we have seen many that are not so clear.  The perfect example of this is the hyperactive child.  Do they all hyperactive children have ADD?  Some difference and eccentricity is normal and attempts to correct it are not the answer.  

We all have, as a part of our nature, the fundamental freedom to comport our selves to the world with an attitude that is open to God's truth and creation.  We can fundamentally change our attitude and receive with an open heart the world that is given to us, with its order of values and purpose.  This transformation when coupled with prayer and devotion provides a fundamentally ordered life.  It can lead to a life not fully determined by diagnosis which is defined by some set of symptoms where controlling every little deviance from the supposed norm, which presupposes some idea of perfection, becomes a distracting obsession.  Identifying psychological conditions that are truly caused by physiological issues can be helpful.  However, the most important thing most folks can do is turn to the Lord in prayer and turn to the world with a Christian attitude.  Doing that is the only thing that will order our imperfect world.

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