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-   -   DSM-5.IRD: An Insurance Reimbursement Disorder (http://www.behavior.net/bolforums/showthread.php?t=3950)

Henry Stein March 18th, 2012 07:39 PM

DSM-5.IRD: An Insurance Reimbursement Disorder
 
After half a century of morphing from Freudian roots into a psychiatric-pharmaceutical bonanza, DSM-5 has secured a prominent place within the free market as a handbook for massive profit generation. Now, with 360 reimbursable diagnoses, it continues to grow into a gigantic encyclopedia of socially difficult and inconvenient behavior that can sometimes be minimized (but never cured) with medication. By contrast, nearly a century ago, Alfred Adler suggested that most (but not all) psychological symptoms have an unconscious purpose, and that they may be used by discouraged individuals for fictional self-enhancement and the illusion of self-protection. Adler's unique, profound "psychology of use," compared to many "psychologies of possession," provides a socially illuminating perspective on psychological disorders by examining the impact of behavior and feelings on partners, families, and ultimately society.

His elegant conception of "the unity and diversity of disorders" offers a penetrating insight into psychological symptoms. Assumed causes and elaborate descriptions of symptoms are interesting, but the perception of purpose is the most helpful therapeutically. Each client, regardless of symptoms similar to others, is unique, striving unconsciously to realize a fantasy compensation for their discouragement. With rare and keen insight, Adler pointed out that every patient has the appropriate thinking, feeling, behavior, and symptoms to pursue his or her unconscious goal. Diagnostically, we are challenged to discover and share that unique portrait with a client so that he or she feels deeply recognized and understood. Adler's construct of the unconscious, fictional, final goal, cannot be measured, but it can be guessed with artistic intuition. Then we must gradually share that insight with a client while we also create a unique therapeutic strategy for helping that individual move in a different direction.

The 360 Procrustean beds of DSM-5 are an insult to the creative uniqueness of individuals. "Evidence based treatment" sounds impressive, but it might be prudent to examine the research more carefully and critically. Recent challenges to the evasive research methods used by pharmaceutical companies should cast a more skeptical light on psychotherapy research motives, methods, and results. Lastly, the potential counter-placebo effect of DSM5 should be explored. Just as many patients have experienced relief from sugar pills, having been unconsciously influenced by their expectations, we cannot rule out the potential of psychiatrists and pharmaceutical companies finding or even inventing a never-ending goldmine of new diagnoses, driven by the expectation of profit.


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