An Interview with Jack Carney DSW: Boycotting the DSM-5 ?

Feb 13, 2013 by

dsm5Michael F. Shaughnessy –

1) First of all, Dr. Carney, can you tell us about your education, background, and experience?

I received a BA/History/Fordham/1964; got my MSW/grass roots organizing/UCLA/1969; and Doctorate in Social Work/clinical social work/ from City University of New York in 1991.

Began working with poor folks in the Peace Corps/Colombia/1964-7; continued with work with Latinos in East LA while I was pursuing my MSW; continued when I returned to NYC in 1971 and began working as a community organizer in a storefront in Sunset Park, Brooklyn, employed by Maimonides Community Mental Health Center; formally began working in the public mental health system when I requested transfer to Maimonides in-patient unit after Maimonides lost its Federal community outreach funding in 1976. Worked at Maimonides — in-patient; day hospital and day treatment; out-patient — until 1989; while there, completed 3 yr. training in family systems therapy and completed research and doctoral dissertation re psycho-educational multi-family therapy for persons with schizophrenia and their families.

I went to work at Hunter School of Social Work as Director of Training and Curriculum Development for NYS’s new Intensive Case Management Program, writing all training curricula – 1989-1993; left to take up job I held until my retirement in 2010 — FEGS Citywide NYC ICM Program; ultimately, responsible for caseload of 900 persons diagnosed with serious mental illness and staff of 50 case managers and support staff. During the last decade of my tenure, began my conversion away from the bio-medical model to one rooted in environmental causation, particularly trauma.

WE noted that a large number of our clients were dying at a relatively early age — median 55 — of cardiac related illnesses (often triggered by diabetes) at rate 2/5x higher than average Americans; which conformed to the emerging national research, which had also identified a clear causal link to neuroleptic medications.

From 2006-10, we initiated a campaign to address our clients’ medical needs and their psychoactive medications, training all ICMs and 100 of their clients as primary care self-advocates; developed a 16-hour training program where participants presented with candid review of the dangers presented by their prescribed medications and the various steps they could take to remedy the consequent problems — diet, exercise, self-advocacy. Great personal results for our trainees, but little systems impact.

When I retired to FEGS, turned to unfettered systems change and advocacy, principally via my blogging, and now via the boycott.

2) Now who started this committee to boycott the DSM-5?

I first suggested a Boycott of the DSM-5 in a blog post on MIA in May, 2012; posted several subsequent articles re the DSM, including one in December, which attracted interest of DR. Dan Fisher;, well-known psychiatric survivor and psychiatrist; he agreed to join me in organizing a boycott; after which I recruited Dr. Joanne Cacciatore, a bereavement expert and founder of the MISS Foundation for bereaved parents and family members — ferocious opponent of the DSM-5’s bereavement exclusion. Began our efforts by drafting our Boycott Statement, proceeded to recruit other Committee members, who now number 15 and growing.

3) What do YOU think is wrong with the DSM-5, and what does the committee think is wrong with the DSM-5?

Committee members and I on same wave length re these issues; which is why they joined the Committee. First, DSM is rooted in biomedical model, which, after years of research, has no found scientific basis; in short, its increasing # of diagnoses appear to be the inventions of research psychiatrists who have undertaken years of fruitless research to validate their suppositions about human behavior. In research terms — no construct validity and poor inter-rater reliability: i.e., psychiatrists can’t agree among themselves what a diagnosis means or signifies. Further, and congruent with diagnoses, the DSM’s epistemology — its diagnoses — and its nosology — categorization of diagnoses — are ultimately reductive, which counters the very notion of human experience; latter best understood as discursive, i.e., rooted in highly idiosyncratic, i.e., personalized, narrative. Which brings us to last salient point — inferred treatment. Psychotherapy consists, in its essence, in a psychotherapist listening while her/his patient, i.e., the person seeking help, tells her/his story. This basic notion seems entirely ignored in the new DSM — no mention at all of environmental or real life experiences as causative factors in people’s distress; rather, one is left with the notion that the best, perhaps only form of legitimate, i.e., effective, treatment is the prescription of psychoactive meds; usually decided on, along with a dx., after one 1.5 hour evaluation session whose focus is to determine congruence between DSM’s putative diagnostic criteria and the patient’s reported behaviors. Little interest evinced by the treating person in her/his patient’s nuanced personal history. Once diagnosis established and problem behaviors or symptoms identified, prescription of meds follows.

In sum, a wholly reductive process, leaving one to ask, “Where is the person who’s come for help?” Doesn’t work plus accumulating evidence that medications quite toxic, particularly when they are managed in such an off-handed way by most prescribers, including the primary care physicians who are the principal prescribers in the country.

Meds will only do no harm — best that often can be expected of them — if the prescriber elicits and welcomes feedback from the persons being prescribed the meds. Rarely happens and is not promoted in any DSM.

4) A month or so ago, I interviewed Dr. Allen Frances, who listed about ten major concerns he had about the DSM-5. I respect his position. Do you and your committee differ at all from his ideas?

Fundament and irresolvable differences with Dr. Frances, who still believes in the utility of the DSM, provided, apparently, it ends with DSM IV, the edition he edited. Specifically, he continues to subscribe to the biomedical model — we see it is as the fundament source of the problem; accordingly, he subscribes to the effectiveness of psychoactive meds — we regard them as essentially problematic; with whatever utility they may have undermined by practitioners who, unlike any other physicians, prescribe psychoactive meds prophylactically; which completes the biomedical tautology: if mental illness is rooted characterologically in the distressed person’s biology, he/she will always be “sick” and will therefore constantly need to be medicated. We reject all those concepts.

We had an ultimate falling out with Dr. Frances over the Boycott and our insistence to define Boycott, in the face of his opposition, to mean, as per the American Heritage Dictionary, not to buy or use the object being boycotted.

5) It seems to me that the world out there, doesn’t care very much about the difference between a personality disorder and schizophrenia. Am I off on this?

Not too far off, which is the problem with putative biologically-rooted disorders. Research has shown that the general public is more likely to shun or regard suspiciously persons believed to have inherent, irremediable problems, a la the biomedical model; less likely to be interested in deciphering one diagnostic category from the next. However, much more sympathetic to individuals said to be suffering from problems consequent to environmental causes, i.e., trauma victims, the source of whose problems come from outside of themselves, often from others. Research has also shown that negative opinions of persons identified as mentally ill is reduced via personal contact between john q public and the persons with the diagnoses.

6) It also seems to me that a lot of people really don’t know the difference between Axis I and II and III and IV and V. Is the DSM-5 just an intellectual exercise to some people?

All the DSMs can be construed as intellectual exercises for practitioners when the latter are divorced from the true emotional life of the persons coming to them for help. Which is why i characterized the DSM and its diagnostic categories above as reductive — the person gets lost and can become irrelevant to the presumed treatment process.

7 ) It also seems that we have way too many people running around with guns and killing children in schools that should have been correctly diagnosed and institutionalized, but were not. Am I off on this?

Your characterizations are off. As I’ve written in my several posts about mass shootings, particularly after Aurora and Newtown, the folks who did those shootings are representative of only about 20% of all those who commit murder en masse. Further, they are folks who are utterly disinterested in treatment — too suspicious of others; and, should they come in contact with mental health practitioners, as the Aurora, Newtown and Va. Tech shooters did, their involvement will be brief and unproductive.

Treatment as we usually understand it — psychotherapy and/or meds — is totally voluntary; it will have no impact on the person apparently needing help unless he/she becomes engaged in a relationship with the treating person. None of these guys was interested in treatment. That would appear to leave involuntary commitment as the only alternative — at which point that ceases to be treatment and becomes a strategy of social control and, if inpatient, incarceration. Which brings us to the key point of the mental health measures currently being bruited about — should we marginalize as inherently dangerous several million people who are the least likely among us to commit an act of violence — only 4% of violent crimes committed by persons with MI diagnoses; only 2% of crimes with guns committed by persons with MI diagnoses. Actually, quite a comment on a society so obsessed with guns and violence. Who’s really crazy here?

8) Further, it also seems that we have this “Out-patient mentality” that as long we some psychiatrist is medicating them, that they are no longer a danger or menace to society. But the Aurora Colorado movie killer seems to prove that incorrect. Your thoughts?

Two points — medications have to be actually ingested. Again, research shows no relationship, no medication compliance. Which is why 50% of all Americans never fully comply with their prescribed medications regimens. Most importantly, all psychoactive medications are of suspect effectiveness. Research done in the UK is beginning to demonstrate that individuals who have difficulty metabolizing neuroleptic meds (the so-called anti-psychotics) show an increase in akathisia (involuntary motor movements), which leads to an increase in motor agitation and potential for violent behavior; similarly, research on SSRI’s has shown that adolescents prescribed SSRI’s in this country have an increased risk for self-harm; which is why most SSRI’s have black box warnings re the SSRIs. In sum, no panaceas and a real potential for an increase in harmful behaviors.

9) I understand you are going to boycott the buying of the DSM-V book. Who are you sending a message to, and do you think it will work?

Have no certainty that the Boycott will achieve our desired effects — obtaining upwards of 25K signatures, curtailing sales of the new DSM and allowing us to pursue our next objective, which is to engage practitioners in a conversation re the need to affix a diagnosis to anyone. Our intended audience is universal, i.e., everyone — practitioners, users of services, their family members and friends, advocates, psychiatric survivors — whose had adverse experiences with the mental health system and is interested in changing how that system operates.

10) What have I neglected to ask?

I think we’ve covered everything. If anything should occur to you consequent to reading what I wrote, just ask. The research I make reference to can be found in the REFERENCE sections of the pertinent essays I have posted on MIA.

Thanks for your interest and for the opportunity to expose you to my and The Committee’s point of view.

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