Learn how social factors promote mental health, influence the onset and course of mental illness, and affect how mental illnesses are diagnosed and treated. This course explores how our understanding of mental health and illness has been influenced by social attitudes and social developments in North America and around the world. The course begins by situating our contemporary mental health practices in historical context, then looks at different aspects of mental health, mental illness and mental health services and their connections to what’s going on in our social environment.
From summer 2014: what's with the DSM?
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Del curso dictado por University of Toronto
The Social Context of Mental Health and Illness
94 calificaciones
De la lección
The social context of diagnosis and treatment of mental illnesses
Conoce a los instructores
Charmaine WilliamsAssociate Professor
Faculty of Social Work
[BLANK AUDIO]. Hello everyone.
Professor Charmaine Williams here dropping in to the course to discuss what
this time around, seems to be my most controversial choice, which was the the
the video, called psychiatry's deadliest scam about the DSM.
So yeah, you know I can never predict which, which things really are going to
catch people, really get them sort of worked up in this course.
But I love, that it get's people worked up because you know the reason I did this
course, is because I wanted people to be talking about these issues.
Thinking about them working through them, and it's clear that's what you're doing,
and I wish I had the time to really cover the discussion forums more thoroughly,
but certainly, this is the one that caught my eye.
So I though I'd come in and do a quick commentary on it, and I'll posit it right
away, but I'll also send it for closed captioning because I know a lot of you
depend on that. And so, if you are having difficulty
following me, check back in a couple of days and there should be subtitles.
So the first thing is, why on earth did I put up a video [LAUGH] that has been, you
know, partly created, sponsored, whatever by the Church of Scientology, which is
clearly an anti-psychiatry institution? Why would I choose that as the video to
explain or start the explanation of the DSM for you?
Well, the reason that I put that up is because [LAUGH], it was this really
interesting example of how it sort of, it, it actually took you through the
facts in some way of how the DSM is put together, but distorted them so
incredibly because of their own political.
their own political perspective in terms of wanting to discredit psychiatry.
So I, I have to apologize because I know that, that maybe I should have explained
that first because often in university we assign things, not because we think it's
the best possible source of information. In fact, I think, you should be skeptical
of anything, which just means bring your bring your thinking brain with you
because the thing is you want to think about does what this person's making,
saying make sense. And when we look at that video the fact
that they've got these people throwing around cards and there's like all this
darkness and circus music and all of this sort of thing, I actually think of it was
giving you a pretty strong indication that you should question the validity of
what these people were saying. But that being said, I don't want you to
feel like you missed the boat if you didn't immediately feel skeptical about
what they were saying because the funny thing is that since DSM-5 has come out I
mean everybody has something bad to say about it and and I actually was going to
give you a link to something I could find online.
I was looking for something online. That would explain the, the changes in
DSM-5 in a way that would be clear and helpful to people in the class.
But the reason I'm here in person instead of doing that is because I could not find
anything that did not similarly distort the facts.
And, present them in a way that, that really, I think, misrepresents what that
process was about. And just to put it in perspective, I can
tell you. Because I teach mental health courses
here at the University of Toronto. People have asked me about the DSM.
And they they say to me like I got the DSM-5 here, see?
I've got pieces of paper in it because I'm planning to write something with my
own criticism of the DSM-5 so add me to the people who think there's, that it's
not perfect. Add me to that list.
But people have said to me. Oh, I heard that the, the way that they,
the, disorders get in there is the pharmaceutical companies sponsor the
research and that's how it gets in there. But that is absolutely not true.
It's just absolutely not true. But the thing is you hear these things,
you hear that the pharmaceutical companies are all in it.
You hear that they vote on the disorders which makes it sound like it's a
popularity contest instead of actually a group of.
Scientifically trained people looking at the evidence and trying to develop some
kind of a consensus around what's acceptable and what needs further study.
You hear these things, and it makes it sound like the whole situation is
completely indefensible. So, here's what I can tell you about the
DSM-5 [LAUGH]. What I can tell you is, there is a very
careful process that goes into putting together these manuals, but everybody
knows they're not perfect. Every DSM, the reason we have five of
them is, and why we know we're going to have more of them is because as we learn
more and do more. And understand more.
We have to change what goes into that diagnostic and statistical manual.
So this DSM-5, published in May 2013 represents our best knowledge at the
moment. What we think is out best knowledge at
the moment. It will be replaced by better knowledge
later. Okay, so that's one thing I can tell you.
Another thing is the kind of changes that have been in DSM, well, you're going to
find a zillion articles about what the changes have been.
there's one in Psychology Today that I just saw, the ten worst changes in DSM-5.
Nobody talks about the good changes, they only talk about the ones they think are
bad. And basically what they do is they
present the changes that they think are most important based on their own
interests. So my pieces of paper here are because I
want to write an article about what DSM has done or not done to integrate issues
of race, ethnicity, and culture into the diagnostic and statistical manual.
So if you ask me, what's changed in DSM-5, I'm going to talk about that.
If I'm somebody who dose autism research then my conversation about what's changed
in the DSM-5 is going to be all about how they have gotten rid of the categories in
between. And now made it just about where you
where you are in the spectrum, completely erasing this group of people that we used
to call. that we used to say that we were
diagnosed with Asperger's syndrome. These people have developed an entire
sort of cultural identity around having Asperger's syndrome and calling
themselves Aspee's and, and in this you know in the process of developing DSM-5
poof it's gone from the manual, doesn't mean they're not still there.
Other people will talk to you like if you're interested in gender identity.
It's very interesting to know that now gender identity disorder is gone.
And what we talk about is it's dysphoria it's a type of dysphoria , which means
that you're only going to give the diagnosis now if your gender identity is
causing you emotional distress. Which, I think makes sense.
You know, now, it's like it's not that the actual identity has pathologized, but
if you were having problems because of the identity, that's considered something
that needs treatment or intervention of some kind.
Now because we are students of the social context of mental health and illness we
know, we are thinking, [LAUGH], that, you know?
The distress that people experience because of gender identity is still very
much a social phenomena. It's not inherent to gender identity.
Or, a minority gender identity to be experiencing dysphoria.
But somehow, this is now being located in individuals.
But the flip side of that is. The, the existence of some kind of
diagnostic category still creates that space where people can get help, if they
need it, when they need it. So that's another change.
And then there are, you know, there are new diagnoses, there are other diagnoses
that have gone. That, that other people think shouldn't
have gone. There are like a million little changes
on DSM-5. And then also a number of things that
have been put in this category of things we need to look at more closely.
So, those are the summary of changes. So, what should you, as a consumer as
somebody, who's in the public wondering what this means for you, what what do you
take from that? I think what you take from that is that.
The DSM is one source of information that people use to try to understand what
causes or, no not what causes. What the, what they used it for is to try
to describe the kind of distress that people may be experiencing.
That's all it is. It's just a tool.
And it's one of many tools, hopefully, people use to try to help and support
people who are dealing with issues of mental distress.
and then in terms of like, you know, these, the people who will come along and
say, don't use it, psychaitry is deadly, all these sort of things.
I think that you have to come to your own conclusions about what works for you as
an individual, what makes sense to you as an individual.
And I think that you should not think that because you don't have a bunch of
degrees, that you're not in, you, you can't have an opinion on this.
Because we all question these things. None of us have a definitive answer to
this, and even the people who sit on the DSM-5 panel, all they've done is given
their best effort to do a process that is that is systematic, that is careful, that
is considering the social context in terms of what is acceptable and what
isn't. And is as impartial as it can be.
But they're human beings. It's not perfect.
So that's what I'd say about the DSM. I'm just going to take a quick look at my
notes to see if there's anything else that I wanted to mention.
Oh yeah, there's one thing that somebody asked about the kind of research that's
available to actually validate mental illness particularly this question of
whether it's actually linked to chemical imbalances.
So what I'm going to say is, I'm a social worker, I'm not exactly the best person
to ask about that. But, I think the thing is there are
actually really good efforts by institutions like the National
Institution of Mental Health in the US, the Center for Addiction and Mental
Health in Canada. Those are the ones I know best and and
probably other similar large psychiatric organizations in different parts of the
world. Everybody's making an effort to try to
put information out that's useful to the public that talks about things like how
we make diagnosis and where those diagnoses come from and I'm hoping that
people are going to get better about putting out information about the DSM so
that you can make your, you know an educated decision about whether this is
something you have confidence in or not. But, this question of chemical
imbalances, it's a tough one. I think that, you know, we don't
necessarily have the tools to detect those things right now.
We do a lot of brain scanning and, and we sort of try to make links between what we
see in brain scans and what people are experiencing emotionally, behaviorally
and cognitively. but I don't know that we have a clear
answer on whether these things can be linked to either brain function or brain
structure. When we do what we tend, when we find
those kinds of answers, what we tend to do is start talking about them as
neurological disorders rather than mental illnesses.
And probably the best example I have of that is how we are increasingly
understanding dementia as a disorder of cognitive functioning with neurological
correlates that we can see on autopsy. I don't know if we're going to be able to
find the same kind of think for every disorder.
So I mean this is partly why I'm very invested in trying to understand the
social context. I don't know if we're going to find all
the biological answers. anytime soon.
I don't now we're going to find all the biological answers in my life time.
But what I know is that there're social consequences that we have to deal with,
psychological consequences that we have to deal with and I do a course like this
because I want us all to be better able to do that.
Okay? So.
No clear answers but I hope that this addresses some of the questions that are
floating around. And keep up the discussion.
I think, I'm thrilled that you guys are talking about this and starting it out
and sharing your opinions. And and yeah, keep that up.
Alright, talk to you later.
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