In the run-up to next week’s much-awaited publication of DSM-5 (the fifth edition of the American Psychological Association‘s hugely influential Diagnostic and Statistical Manual), there has been a bit of a rumpus.

The British Psychological Society‘s Division of Clinical Psychology is calling for a “paradigm shift” in how mental health issues are understood, pointing to assumptions about biological causes of mental ill health as unhelpful and suggesting instead that a wider approach be taken that also looks at social and psychological environments.

The New York Times, meanwhile, claims that practising mental health professionals won’t be paying much attention to the latest edition of the diagnostic bible, with Sally Satel arguing instead that the DSM‘s influence lies much more particularly in the fields of health insurance and access to specialist educational services and disability benefits.

In some ways, new diagnosis guidelines in the DSM are heralded in much the same way as new slang terms making it into the Oxford English Dictionary, provoking debate and sometimes outrage. It’s also a zeitgeist-watching tool par excellence; back in 1973, ‘homosexuality’ as a disorder was finally removed from the DSM, for example. DSM-5, in turn, replaces ‘gender identity disorder’ with ‘gender dysphoria’, in an attempt to destigmatize those who believe they were born into the wrong physical gender.

In the UK, the World Health Organisation‘s ICD (International Classification of Diseases) manual is officially used in mental health diagnosis instead of the DSM, so other than the usual ‘transatlantic influence’ route, we are not directly affected, strictly speaking. But the arrival of the fifth edition of DSM, a decade and a half in the making, gives us good cause to think twice about diagnosis in mental health. For some patients / clients, diagnosis of a recognised condition can offer untold relief, as described publicly by both Stephen Fry and Paddy Considine (see my related blog post) in recent years. For others, however, a ‘label’ can be a very negative thing, seriously affecting both self-identity and the way people are seen by their friends, families, colleagues and bosses – as well as by medical professionals, sadly.

In yesterday’s Observer, clinical psychologist Oliver James raises serious concerns about using genetic or neurological markers to identify mental ill health, arguing instead that early childhood experiences plus problems in adulthood are the major contributors to mental distress. In particular, he singles out psychosis, writing that “it is becoming apparent that abuse is the major cause of psychoses” [my italics].

In psychotherapy, we are trained to work with the person and his or her history, circumstances and environment rather than with diagnoses. Further than that, I have often asked clients during their initial consultation to talk about themselves rather than their supposed conditions or whatever other medical professionals might have labelled them. It’s been surprising to what extent this has brought immediate relief as well as a willingness to work hard in therapy to determine causes, behaviours and contributing factors – which are always complex and multi-faceted.

DSM-5 notwithstanding, discussion around diagnosis among mental health practitioners of all persuasions is very welcome, and it’s reassuring to see colleagues from psychology and psychiatry sticking their heads above the parapet to question the long-established authority of diagnoses, the effects of diagnosis upon patients, and within all this, the medical model itself.