After DSM-5: A Critical Mental Health Research Agenda for the 21st Century

This special issue of Research on Social Work Practice focuses on a critical assessment of the Diagnostic and Statistic Manual of Mental Disorders, fifth edition (DSM-5; American Psychiatric Association, 2013). This is the first substantial revision of the DSM since 1994. Given the major impact of the DSM on the field of mental health and beyond, it stands to reason why clinicians, scholars, and the general public are interested in the newest edition of the ‘‘psychiatric bible.’’ However, the development and release of the DSM-5 has been accompanied by an unprecedented level of public debate and protest (Kirk, Cohen, & Gomory, in press). In just a few short years, a sizeable literature assessing and criticizing DSM-5 has emerged (e.g., Frances, 2013a, 2013b; Greenberg, 2013; Kirk, Gomory, & and Cohen, 2013). A public petition asking for an independent scientific review of the DSM-5 was endorsed by at least 47 mental health organizations (Frances, 2012a). Jack Carney, DSW, a longtime clinical social worker, organized a boycott of the DSM-5 and asked ‘‘Where are the Social Workers?’’ (Frances, 2012b; Frances & Jones, 2014). However, the National Association of Social Workers has not taken a stand on DSM-5 (Littrell & Lacasse, 2012a). This special issue seeks to add to this emerging literature by critically examining the DSM-5 from the perspective of social work (see also Wakefield, 2013a, 2013b). The DSM-5 has created controversy for a variety of reasons. Some are specific to the DSM-5, while others are issues that would apply to previous editions of the DSM as well. While objections to the DSM-5 are detailed in the scholarly literature (both in this special issue and beyond), a brief catalog of the perceived problems with the new DSM provides useful context: The reliability and the validity of the DSM-5 are challenged based on the empirical data (Kirk et al., 2013; Mallett, 2014; Spitzer, Endicott, & Williams, 2012). The DSM-5 continues the reification of disorders despite compelling counterevidence (Wong, 2014). While the creators of the DSM-IV were concerned with false-positive diagnoses, DSM-5 has expanded the boundaries of mental disorder and medicalized many more human problems (Frances, 2013a, 2013b; Gambrill, 2014; Jacobs, 2014; see also Thyer, 2014). The removal of the bereavement exclusion (Thieleman & Cacciatore, 2014; Wakefield & Schmitz, 2014) and the creation of binge-eating disorder and mild neurocognitive disorder are examples of potential medicalization (Frances, 2013a, 2013b; Myers & Wiman, 2014). Changes to the autism spectrum disorder (ASD) have caused significant controversy (Greenberg, 2013; Linton, Krcek, Sensui, & Spillers, 2014). The DSM-5 developers also removed the multiaxial system, including Axis IV, sometimes called the ‘‘social work axis’’ (Probst, 2014). Accompanying these and many other DSM-5 controversies (Frances, 2013a, 2013b; Wakefield, 2013b), there is a general impression that the American Psychiatric Association has bungled the development and release of DSM-5. The sources of these criticisms included prominent psychiatrists Robert Spitzer (Chair of DSM-III and DSM-III-R) and Allen Frances (Chair of DSM-IV and DSM-IV-TR). They publicly objected to the lack of transparency within the DSM-5 process (e.g., Spitzer, 2009). While the original hope was that developments in neuroscience would uncover specific brain lesions allowing DSM mental disorder categories to ‘‘map onto the brain,’’ providing for an integration of neuroscience and psychiatry under DSM-5, no such scientific findings appeared. This has raised the question of why a new DSM is needed at this time (Frances, 2009). To make matters worse, publication of the DSM-5 was rushed, leading to copyediting errors in the printed edition, some of which could impact clients (Frances, 2013c). At times, it has seemed that the APA has behaved very much like a corporation seeking profit and influence rather than a scientific organization charged with the crucially important task of defining mental disorders. Some have argued that the motivations of the APA are not scientific but primarily financial (e.g., Frances, 2012c, 2012d). Rather than engaging with the scholarly criticisms of the DSM-5 and mounting a credible defense of their scientific work, the APA worked to suppress critical discussion (see Greenberg, 2013, pp. 282–283, 292– 295, 338). For example, the APA claimed that anyone writing a narrative account of the DSM-5 needed their permission. This led Gary Greenberg to compare the APA to ‘‘bumbling Kremlin bureaucrats’’—and to question whether a private guild with close ties to the pharmaceutical industry should be entrusted by