Time for a Paradigm Shift in Psychiatric Diagnosis
The British Psychological Society’s Division of Clinical Psychology (DCP) has published a consensus statement on psychiatric diagnosis: Position Statement on the Classification of Behaviour and Experience in Relation to Functional Psychiatric Diagnoses: Time for a Paradigm Shift. It advocates a paradigm shift in how we understand mental distress towards one which is no longer based on diagnosis and a ‘disease’ model.
The development of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders has revived debates about the conceptual foundation of psychiatric diagnosis, its research base, the ways it shapes professional practice and the impact it has service users. The DCP statement was drawn up by a working party of clinical psychologists and service user/carer representatives on the basis of broad consultation with the various Faculties, and after a careful consideration of the key theoretical, empirical and ethical issues in relation to diagnosis. It reflects concerns raised by many other professional and service user groups, including psychiatrists (Bracken et al, 2012).
The DCP believes there is need to move away from psychiatric diagnoses such as schizophrenia, Attention Deficit Hyperactivity Disorder, personality disorder and conduct disorder, which have significant conceptual and empirical limitations, and develop alternative approaches which recognise the centrality of the complex range of life experiences in the emergence of mental distress, and the personal impact of social and relational circumstances including trauma.
Service user Jo Hemingfield, a member of the working party, said: "For too long people like me have been labelled with psychiatric disorders and left on the scrap heap. Now is the time for a fresh look at these times of distress so we can pick our lives up with a new sense of hope and without being weighed down by inaccurate and unhelpful labels".
The DCP recognises that for the immediate future, psychiatric diagnosis will still be needed in order to determine access to services, eligibility for benefits, and other purposes. At the same time, the DCP wishes to work with partners from all professions, and with service users and carers, to develop a new paradigm which would integrate and do justice to the complex interactions between social, psychological and biological factors in mental distress, and recognise the importance of service users’ and carers’ life experiences, struggles and strengths. In the meantime the DCP continues to advocate the use of psychological formulation, which brings together research and evidence about particular difficulties, along with the person’s own life experiences and understandings, to create an individual summary about how the problems came about and what will help. In this collaborative process, relevant psychological, social and biological factors can be combined with personal meanings in order to indicate the most effective evidence-based way forward.
Richard Pemberton, the chair of the Division of Clinical Psychology said: "This is the latest in a series of documents arguing for psychological and interdisciplinary understanding of experiences such as hearing voices, despair and mood swings. Our statement calls for a paradigm shift away from an outdated disease models, towards one which gives much more weight to service user experience and psychosocial approaches."