Can the DSM be replaced?

March 1, 2022

Good morning, MindSite News readers. In today’s newsletter: Therapists and mental health researchers continue to challenge and create new alternatives to psychiatry’s diagnostic bible. Ruckers put a load on their backs – and find it therapeutic. And Dr. Bronner’s is not only promoting world peace, it’s putting some of its profits into the push to develop psychedelic therapies.

Want to tone your core and ease your angst? Gotta keep on ruckin’

Need a mood boost? How about taking a good long hike outside while wearing a 30-pound backpack. The exercise is called “rucking” (after “rucksack” – aka backpack) and it’s becoming a major mood enhancer for people seeking to build endurance, improve cardiovascular function, and gain mental clarity, according to the Toronto Star. It has grown in popularity since the start of the pandemic, the Star reports. 

Why? Here are two good reasons: Studies, including one from the U.K., show that people who take group walks in nature have less depression and perceived stress and greater wellbeing. Plus it can burn two to three times as many calories as walking without weight and confers cardio benefits comparable to jogging, according to researchers at the University of South Carolina.

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The revolt against psychiatry’s bible continues 

The Diagnostic and Statistical Manual of Mental Disorders, or DSM for short, has long guided the field of psychiatry in the United States. The so-called bible of psychiatry, published by the American Psychiatric Association (APA) contains the lists of symptoms and criteria used to diagnose every mental health condition. Basically, if it’s not in the book, it’s not considered a disorder and won’t be reimbursed by insurers and other payers. The DSM has been controversial for decades – critics say it’s reductionist, tends to pathologize normal reactions and behavior and boils down complex conditions to checklists of symptoms. When the latest edition, the DSM-V, came out in 2013, it spurred criticism and a heated petition campaign from psychologists and counselors. 

Now, some mental health researchers are proposing new ways of assessing mental health and psychopathology – and doing away with the DSM. Wired magazine reported on the controversy, including arguments that the DSM continues to essentially manufacture disorders that otherwise might not be seen as problems, while also treating conditions with overlapping symptoms as “comorbidities” that are all but inevitable.

To address these issues, some professionals suggest a new hierarchical system of diagnosis called HiTOP – the Hierarchical Taxonomy Of Psychopathology. HiTOP aims to replace symptom checklists and instead to view mental distress across a spectrum. Social anxiety, for example –  to use a DSM-V classification – ranges from people who experience mild discomfort in some situations to those who are fearful most of the time they’re around other people.

Others wish to go further. The Power Threat Meaning Framework (PTMF) developed by a group within the British Psychological Society that has long been critical of the “medical model” of mental illness, wants to eliminate diagnostic categories altogether. It is founded on the idea that mental illness, as we now see it, does not really exist. Rather, it theorizes, people experience mental and emotional difficulties as a result of various traumas they’ve experienced in life, and the way societal forces including racism and poverty have affected them. Therapists in the PMTF school seek to help clients identify these forces and understand their effects as a way to reclaim their power and take part in community-based healing.  

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From soap to psychedelics – Dr. Bronner’s keeps current

“Let’s face it, the world would be a far better place if more people experienced psychedelic medicines,” David Bronner, CEO of Dr. Bronner’s Magic Soaps, told the New York Times. In the interview, he also mentioned that the 74-year-old soap company is among the first in the nation to include ketamine therapy in its employee health care coverage. 

Bronner and his brother Michael, the company president, are grandsons of Emanuel Heilbronner, the founder of Dr. Bronner’s, whose parents died in the Holocaust and whose soap labels calling for unity and world peace on “God’s spaceship” have long had their own psychedelic quality. Beyond supporting the 21 employees (or their dependents) who have used ketamine therapy so far, the Dr. Bronner’s CEO stands behind his statement to the tune of $23 million in gifts to drug advocacy and research organizations. They included efforts to help decriminalize psilocybin in Oregon and Washington D.C., and a nonprofit dedicated to protecting land to grow peyote, a hallucinogenic cactus with ties to certain Native American spiritual practices.

Bronner’s efforts, though seemingly unconventional, are not without scientific merit. Top universities across the nation, including the University of California at Berkeley, Johns Hopkins, and Yale have created research divisions to study how psychedelics can treat anxiety, depression, addiction, and other mental health conditions. And as ketamine therapy for depression becomes a  billion-dollar industry, it hasn’t shown to be a bad investment. Dacher Keltner, a professor of psychology at UC Berkeley told the Times, “We really are at an inflection point where the whole paradigm about these drugs is shifting.”

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In-person learning not a panacea

Returning to school full time has not brought an end to the mental and emotional struggles of many children, according to a report from NBC News. Many parents noticed the challenges their teens had during extended virtual learning and hoped that the return to school would ease their feelings of isolation. But for teens like 15-year-old Hailey Kern from Suffern, New York, going back to the classroom brought major anxiety. “It feels like you’re carrying 100 pounds on your back,” Kern said. 

Dr. Jonathan Slater, a child and adolescent psychiatrist at New York Presbyterian Morgan Stanley Children’s Hospital, said he refers to this generation of teens as Generation U for Uncertainty. “I think the biggest challenges facing youth today are just the uncertainty in what’s going to happen to them,” he said.

Anecdotally, Slater has found more depression and anxiety among teens. Recent data from the Centers for Disease Control and Prevention backs that up. Mental health-related emergency room visits among youth aged 12 to 17 increased by 31 percent in 2020 compared with 2019.  And in February and March 2021, ER visits for suspected suicide attempts were 51 percent higher among girls aged 12-17 than during the same period in 2019.

In other news…

In one year, the Homeless Outreach Team, known as HOT in Grands Rapids, Michigan, helped keep some 200 people experiencing homelessness out of jail and ERs, and directed others to substance and mental health treatment. It’s a notable accomplishment, reported MLive, especially with just 13 people serving on the team. In the future, the team hopes to expand its service to include working with community groups and churches to found a mobile laundromat for the homeless community.

Getting to happy: Parade magazine reports that according to the World Happiness Report, the 12 happiest countries on the globe share most of these traits in common: strong feelings of mutual trust, strong social supports from the government or universal healthcare, minimal amounts of government suspicion, low levels of unemployment, and living wages for those who are employed. 

Headspace is free for teachers and teens: The mobile app Headspace now provides free access to its meditation and mindfulness library for educators and teens, according to the newsletter of the California Teachers Association. It gives educators free supplemental teaching resources to support social emotional learning, while teens will find age-relevant content and opportunities to help raise awareness around mental health and peer support in their schools. 

The Alabama Daily News reported that several facilities within the Alabama Department of Corrections will showcase artworks in an exhibit titled “Changing the Course: Art by the Currently & Formerly Incarcerated now through April 15. Admission to the exhibit is free—but its value goes beyond sharing beautiful artwork with the public. In a statement about the exhibit, Cam Ward, the director of the Bureau of Prisons and Paroles, said: “Therapy programs, including art-based instruction, have proven to not only reduce recidivism, but also to improve the lives of those suffering with mental illness.”

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If you or anyone you know is considering suicide, call the National Suicide Prevention Lifeline at 1-800-273-8255. And if you’re a veteran, press 1.

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