In its Nov. 3, 2000 issue of Psychiatric News, the American Psychiatric Association announced plans for developing the fifth version (DSM-V) of its highly successful Diagnostic and Statistical Manual series. These manuals have set forth, each in its own time, the psychiatric profession’s agreements as to the conditions it treats and how they shall be identified and named. Even if each of the individual products (DSM-I through DSM-IV, with some interim versions) has had serious problems, the iterative strategy underlying the sequence of volumes is flawless(1). The discussion of the groundwork for DSM-V makes clear that, as this iterative process continues, the tracks are being firmly laid for psychiatry to take its place as a sound, biologically-based and data-based medical specialty.
Psychologists should enthusiastically applaud our psychiatric colleagues, and then lapse into a (psychological, not psychiatric) panic attack! The psychiatric train is moving, on ever more secure medical and biological tracks, but the tracks lead away from, not toward, psychology’s stations. They ill serve psychology’s information-processes-powered trucks, that should run on behavioral highways toward coping skills destinations, not bump endlessly over unsuitable biochemical ties that support the psychiatric train toward medical goals. We may be the porters on psychiatry’s train, perhaps occasionally the firemen or the mechanics, but we will never be the engineers. We need to start building our own freeways.
Psychologists should note two bits of information in the DSM-V article. First, not a single psychologist is mentioned. That is appropriate, and a reminder that psychiatrists do not see their nomenclature as needing to serve psychology’s goals. Why do we? Why do we? Second, the clear basis of psychiatric explanation is biological, even though behavioral problems often form the content of their diagnoses. The following is a quote:
“[If] psychiatric diagnosis is going to become more scientific… what is the biology of cognition? Of various emotions? Of social interactions? And what is the biochemistry of impulsivity, of gambling?”
Such biologizing of behavior, attention to the chemical hardware while neglecting the complexity and profundity of the information processing software, may be legitimate for medicine. It is not for psychology.
Consider depression. The psychiatric approach is clear, as reflected in the article: “a genetic marker for major depression has been identified.” There undoubtedly as biochemical abnormalities underlying some depressions, and a pharmacological search for relief is indeed desirable. There are nevertheless “information-driven” (i.e., psychological), and severe, depressions in physiologically intact people–e.g., a person depressed because of being passed over for a job promotion that she/he “deserves and is entitled to,” or a spouse refusing the come to terms with the infidelity of a mate who “should love me”–than there are “major depressions” secondary to neurotransmitter or other genetic abnormalities. The information process explanation of these psychological depressions–a rigidity of expectations that blocks acceptance of otherwise available but distasteful information, by forcing coping inertia and essential social immobilization–provides more understanding of the conditions and more precisely informs effective treatment than does a biological explanation, regardless of what biochemical processes may be involved in symptom manifestation.
It is not that a biological or an information-processing approach is inherently better, or worse. It is just that they are fundamentally different, and often applicable to fundamentally different conditions. Does the computer need fixing, or does the software that runs it need fixing? At times, the two approaches are competitive, when they struggle with conditions of unknown characteristics for which the preferred approach is obscure. At other times they are complementary or supplementary. Either can be appropriate or inappropriate, depending on the nature of the problem. Conceptually, they are fundamentally different, one from the other. We should be playing Microsoft to their IBM, not trying to imitate them as “me too” psychiatrists.
Psychiatry’s train has long since left the station and is running on constantly improving biological tracts, toward ever more effective medical treatments of medical conditions. But when, oh when, is psychology as a profession going to start laying behavioral roads for its information processing trucks toward its coping skills destinations? When, oh when, will we acknowledge that we deal with copping processes, the critical software of behavior, not the anatomical hardware of medical or psychiatric abnormality? Information processes drive biochemical hardware and human behavior more than they are driven by the hardware. Biochemistry without information processing is a cadaver. Human anatomy not driven by coping processes belongs in a wax museum.
When we start our own psychological diagnostic and statistical manual that iterates toward psychological professional success, our own nosology (however imperfect at first), our own consistent professional psychological usage, our own cataloging of the outcomes, including the inadequacies, of our approaches, and our own iterative correction (rather than denial) or our ignorances? Isn’t it time we quit trying to hitch rides on psychiatry’s train which is headed away from our station? Isn’t it time we designed our own trucks with information processing engines to deliver coping skills successes, to run on our own behavioral highways?
It can be done. Let’s wake up and do it!
David A. Rodgers, Ph.D., now retired, was a psychologist at the Cleveland Clinic for more than 30 years. Twice a president of his state association in Ohio, he served as an APA Council members and participated, holding leadership roles, in numerous APA activities during his career. He can be contacted at DARodgers@aol.com
(1) The strategy is simple in concept and highly effective, although somewhat difficult in implement:
Develop reliable, even if not entirely valid, diagnostic terminology that all psychiatrists use, for all the conditions that psychiatrist treat as being within their specialty. Initially, this was little more than a somewhat arbitrary and forced agreement on what conditions should be identified as psychiatric and what collection of symptoms should be designated as reliably and uniquely identifying each condition.