A Life Model’s Perspective on the DSM 5

If there was ever an opportunity for me to disrobe in the name of something other than art, it would be in protest of the latest DSM 5. I doubt I’d be the only one to do so and I’m delighted to read about mental health workers who are actively retaliating.

So the DSM 5 – the fifth edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders – has recently been launched spurring a furore of civil resistance one might call a revolution in motion. Tis to be expected, when the labelling of a range of unfortunate human behaviours becomes categorised by the medical ritual of diagnosing, going so far as to determine grief through bereavement as an illness and erratic child behaviour as a disorder to be medicated. What’s your ‘mental illness’?

I couldn’t agree more with Dr Allen Frances who supervised the fourth edition of the DSM. The transcript from Lateline, Normal behaviour defined as illness, is well worth the read. I’m cheering on the sidelines when Dr Frances states: ‘No, I very much support the diagnostic system and I’m a great believer in psychiatry. I’ve seen tens of thousands of patients who’ve benefited from psychiatric treatment. I’m worried about it extending itself too thin beyond its area of competence. Careful diagnosis and careful treatment saves lives and dramatically improves them. What I’m worried about is excessive diagnosis and excessive treatment for the worried well.’ I too have benefitted from the expertise of psychiatry, Dr Frances. There was a time there when had I not had access to medication to shave the edges off my suicidal self, then there would be no Babyfacedassassin. BUT, let’s always look at the bigger picture. Let’s always consider one’s personal evolution. Let’s be real when it comes to psychiatry, its diagnoses and drug dispensary. Do we need it? Do we not? How else might we enact care? What are the other ways we can overcome our challenges that are not based on being sick, ill or disorderly?

Let’s awaken the alchemy of humanity – we are gifted with many ways of placating and transforming pain and suffering. It’s not all about biochemistry and neurons. The heart and soul play a greater role in the formation of happiness and peace. Do we need to understand science to understand love and care?

For me, overcoming depression and self-harm began the day I looked at the core of my demise and step-by-step sought opportunities of triumph. Most people would think that I’m a life model because I am interested in art, nudity and making art from my own nudity. Not so. In the home of my depression lived a horrible bug of shame about my body, my appearance and the fact that I existed. Me being me in my body was cause for suicide. There were a few other factors at play that drove me to my lowest point, in particularly witnessing traumatic experiences at a young age, but as I chipped away at my private existential crises, there was no point denying that my body was a source of self-hatred. My body and my self were not friends.

I’d fallen victim to commercialised beauty and that distorted mindset of beautiful people being more loved than others. Once I got a grip of this kernel of insight to my pain, the life modelling stage beckoned me to boldness. Surely, a space of appreciative artists, creativity and the freedom to be me, skin and bones, was an environment within which I could work towards befriending my body once again. Five years on I believe I have achieved healing through this beautiful avenue of creativity, that would have cost me thousands in psychotherapy and kept me insular rather than connected to the greater community, had I not sought an innovative agent of change.

Nudity for art’s sake has allowed me to defy the many labels that people have pressed on me. Terms like bipolar, clinical depression, psychosispre-menstrual dysphoric disorder and hyper-sensitive can have a real affect on your sense of identity and self-esteem, believe it or not, and these were conditions placed upon me in my youthful vulnerability that went unquestioned. In my adulthood, I started to explore the road of the life model taking all my identities with me. Disrobe after disrobe, they began to fall away. States of meditation entered while modeling alerted me to the fact that my thoughts had nothing to do with being present in my body, and I became masterful at shifting my focus from my mind to physical awareness. Peeling away diagnostic labels with ‘the nude’as my visual metaphor and reference point, allowed me to engage with the comunity even if I was feeling depressed, unstable or left-of centre, yet I was given purpose and meaning in posing for the artists and gave myself the opportunity to witness my psychological, emotional and spiritual nature a step aside from a psychiatric lens. I gave myself a second chance.

I find the artist’s perspective tremendously inclusive, forgiving and unconditional. I am amazed at how artists interpret life in all its mayhem and misunderstandings, yet compose true-to-life renditions of reality in a host of mediums. Genius! And utterly paramount to understanding the human condition.

Title: DSMV  Photographer: Philip Werner

It’s this balancing act of knowing when psychiatry may be a useful intervention during times of extreme psychological, emotional and spiritual distress, and when it may be completely unnecessary and an excessive approach to ‘the worried well’; a balancing act we can all discern for ourselves and for our children when we need support. The Babyfacedassassin is founded on this equilibrium. A balanced approach to mental health care need be our focus. The current medical model of mainstream psychiatry does not provide enough wriggle room for the alternatives that may be of use to an individual who is at a cross-roads. I am time and time again meeting individuals and organisations in the community who diligently look after their mental health and general wellbeing without referring to the DSM 5 for re-assurance. These are people of inspiration within the community exploring human arts designed to re-focus stress, pain, blockages and patterns of behaviour into opportunities for growth, healing and transformation. I’m tremendously excited to be launching a Community Wellbeing Directory in October in honour of these wonderful endeavours.

For the committed reader on the subject, I’ll leave you with a cut-and-paste from Jacqui Dilon’s Hearing Voices Network Launches Debate on DSM-5 and Psychiatric Diagnoses. Her article frames opinions on a variety of issues stemming from the DSM 5.

The following MAIN ISSUES present all that needs to be considered when approaching psychiatry for yourself and for another. She also provides optimism in the face of our medicalised culture, articulating ways that we can move forward to improve our approach to mental health care.

Love Always, Charlotte Claire, The Babyfacedassassin  

Main Issues

from Jacqui Dilon’s Hearing Voices Network Launches Debate on DSM-5 and Psychiatric Diagnoses

Psychiatric diagnoses are scientifically unsound:

  • No objective tests: Unlike most fields of medicine, psychiatric diagnoses are not provided on the basis of objective tests or measures.
  • They’re artificial: There is strong evidence that diagnoses do not represent meaningful clusters of problems or link to known biological abnormalities. Diagnoses are voted into existence by committee, representing opinion rather than scientific fact.
  • Drug company involvement: There is growing concern that new diagnoses are both suggested and shaped by (initiated by) drug company funded research and interests.
  • Unreliable: The diagnosis you receive from a psychiatrist is based on their opinion about what you have told them. Different psychiatrists often have different opinions about the same person, leading to multiple diagnoses. Two people with the same diagnosis may have nothing in common.
  • Limited explanation: Whilst diagnosis seems to provide an explanation for people’s problems, this isn’t the case. People are told they have ‘schizophrenia’ on the basis of their unusual thoughts, experiences, feelings & behaviour. If they then ask why they are having these unusual experiences, they are told it is because they have ‘schizophrenia’. This circular argument explains nothing.
  • Limited use: The issues raised above mean that diagnoses are a flawed basis for deciding on treatment, predicting outcomes and carrying out research.

Psychiatric diagnoses have damaging consequences:

  • Misses the point: Increasing evidence demonstrates mental distress is an understandable reaction to adversity, including: bereavement, loss, poverty, discrimination, trauma, abuse and victimisation. By focusing on ‘what’s wrong with you’, diagnoses can stop professionals asking ‘what’s happened to you’.
  • Missed opportunity: Psychiatric diagnoses can stop people addressing the links between social and economic policy and mental distress. Essential funds are used in the ongoing futile search for genetic markers instead of addressing the societal issues we know lead to mental health problems.
  • Disempowers: Psychiatric diagnosis ignores people’s own explanations for their distress and encourages them to defer to an ‘expert’ for treatment. Having your reality redefined in terms of illness and biology is an incredibly powerful experience that can set the scene for a lifelong psychiatric career.
  • Medication-focused: In diagnoses such as ‘schizophrenia’ treatment is primarily medication, which is becoming increasingly criticised for its harmful effects and lack of efficacy. Medication does nothing to address underlying difficulties.
  • Human rights: People are expected to accept diagnoses for fear of being labelled as ‘lacking in insight’ and having treatment forced on them, violating their basic human rights. Others may, understandably, hide their voices or visions to escape forced treatment – blocking them from receiving help to cope with their experiences.
  • Takes away hope: Diagnoses such as schizophrenia and personality disorder, seen as a life-long condition, can unnecessarily take away people’s hope for a meaningful recovery.
  • Discrimination: People diagnosed with ‘severe and enduring mental illnesses’ are often subject to stigma, discrimination and exclusion. They may have trouble getting insurance, security clearance to travel overseas, and difficulty fostering or adopting children.

A Way Forward

Finding the best way to support those of us who are suffering and struggling to cope without relying on diagnoses and the existing system is a challenge. It can be hard to see what is possible when all we have known is what is available. Still, we want to engage people with lived experience of diagnosis and our allies, in a discussion to create a way forwards.

Our initial ideas include:

  • Seeing mental distress as human and, ultimately, understandable: Rather than seeing voices, visions and extreme states as symptoms of an underlying illness, we believe it is helpful to view them as meaningful experiences – even if we don’t yet know what that meaning is. We believe it’s important to use human language when describing human experiences rather than medical terminology. Given the role of trauma and adversity, we need to start asking ‘what has happened to you?’ rather than ‘what is wrong with you?’
  • Keeping the person in the driving seat: We want people to have the freedom to define their own experience. Support should be based on need, not diagnosis. Equally, people need to access a wide range of alternatives to understand and manage their experiences. Medication is just one way, amongst many, that people may choose. We need information about the pros/cons of each approach – true choice and collaboration, no coercion.
  • Supportive communities: Mental distress is not just the domain of mental health services. Communities have an important role to play in supporting those who are struggling to cope. Community based options can run alongside, and as alternative to, psychiatry. Equally, these approaches must go hand in hand with greater awareness of the causal impact of social factors such as poverty, gender and racial inequalities, unemployment, deprivation and abuse, on mental distress.

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