Diagnosing oppression: A multicultural review of the DSM

At the recent APA Annual Convention in August 2012, Division 32 graduate students Katie Darling, Candy Barlow, Amy Hanes and Demetrius Ford presented “Diagnosing Oppression: A Multicultural review of the DSM.” Under the guidance of Dr. David St. John, professor at the Michigan School of Professional Psychology, these students collaborated to highlight some of the failings of the current DSM IV-TR, and to propose positive changes to the proposed DSM 5 revisions that would support and encourage diversity and multiculturalism. Dr. St. John introduced the panel by discussing the DSM diagnostic system in general, and how it, at times, implicitly discounts an individual’s multicultural identities, and pathologizes normal human experience. 

Katie Darling, a doctoral student at the Michigan School, presented on Neurodiversity. Neurodiversity is an up-and-coming movement in psychology that’s primarily driven by individuals diagnosed, via the current DSM IV-TR, with autism spectrum disorders or attention deficit disorder. These individuals are fighting for recognition of the diversity of the human brain, or put simply, a shift from the binary idea of a healthy brain vs. a disordered brain, to a spectrum of functioning that recognizes individual strengths and weaknesses. The current system is focused solely on limitations and adaptation to the cultural idea of “normal.” While it is important to recognize the challenges that a “Non-neurotypical” individual will face, it is equally important to identify and encourage their unique strengths as well. This approach builds self-confidence, courage and can enhance life satisfaction, as well as our understanding of the diverse range of functioning of the human brain.

Candy Barlow, a doctoral student who has worked extensively with children and adolescents in the Detroit school system presented several examples of the reductionist nature of the DSM system and the diagnosing of adolescents. A narrow focus on symptoms and behavior, especially in the cases of Oppositional Defiant Disorder, only shows a small piece of the puzzle. In her work she has found that a holistic approach to treatment that explores the lifestyle, living environment, and parental involvement in an adolescents life allows her to more accurately address specific needs. In many cases, the Oppositional Defiant Disorder behaviors have been coping mechanisms for survival which are better treated by addressing and changing the environment as opposed to psychiatric medication.

Amy Hanes, a doctoral student at the Michigan School presented on the subject of classism. The DSM system does not take into account many of the unique struggles those individuals in lower socioeconomic classes encounter. For example, a history of being fired, or being late or absent for treatment is many times interpreted as resistance when in fact may be due to unreliable transportation, irregular shift work, and unpredictable childcare arrangements. Symptoms of acute anxiety disorder may be simply a consequence of mounting bills, missed meals or threats of eviction. Again, it is imperative that a holistic approach to clients’ unique situations be considered, something that is currently missing from the DSM system.

Demetrius Ford, a doctoral student at the Michigan School, addressed concerns about the revisions in the DSM 5 that do not adequately consider culture. He described them as “moving the clock back on racial progress.” He expressed concerns that the proposed new edition of the DSM’s revamped definition of personality disorders adds dimensions based on the severity of dysfunctional personality trait domains, rather than potential social and cultural factors that may be contributing to difficulties in living. Lastly, he expressed concerns about the over-diagnosis of Antisocial Personality Disorder in the African-American community, and the potential implicit racism that such misdiagnoses might entail.   

The common thread throughout all of these presentations was a need for the DSM to move away from a binary, reductionist system and towards a holistic approach that appreciates the strengths and weaknesses of each unique individual, their environment, socioeconomic status, and their culture. Until the DSM allows room for the unique diversity of the American people, it will remain an inaccurate, negativistic, diseased focused manual that does little to help and much to hurt.