The New Social Worker Vol. 20, No. 4, Fall 2013 | Page 25

The Great Divide: A Growing Disconnect Between Psychiatric
Research and Clinical Social Work Practice
A response to the DSM-5

I

by SaraKay Smullens, MSW, LCSW, CGP, CFLE, BCD

n your work, you may be encountering an unfortunate reality of the
social work profession and of the
psychological professions in general: researchers and clinicians have not usually
walked hand in hand, consulting and collaborating, complimenting each other’s
efforts. In fact, it too often has seemed as
if the two orientations exist in a universe
unrelated to the other.

In the field of psychiatry, researchoriented psychiatrists and academics
often have little awareness of the solid,
time tested body of knowledge that is
the essence of social work education.
Our emphasis on mutual respect and
lack of condescension toward those we
are privileged to work with, as well as
the deep respect we hold for the innate
capacities of all individuals to grow,
heal, and change, is often overlooked
by researchers in favor of an emphasis
on biomedical, genetic, and neurological factors.

This divide has intensified in recent
decades as psychiatry has become dominated by a growing attempt to categorize
psychological reactions in the same way
medical science categorizes physical
illnesses. Normal conditions are classified as disorders, while at the same time,
many of our clients with serious psychiatric
illnesses who can be accurately and clearly
diagnosed and treated are being neglected.

In brief, those who “talk this talk,”
even those with patient contact, usually
have little understanding or appreciation of the real lives and struggles of our
clients or the body of time tested knowledge and skill we call on as we “walk the
walk” with them. The recent changes
in the Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition (DSM-5)
reflect this unfortunate and widening
schism. According to one of the nation’s
preeminent professors of social work,
Dr. Jerome Wakefield, “The DSM-5 Task
Force would claim that (these) changes
are based on scientific evidence; however, when the evidence is closely examined, this claim turns out to be extremely
exaggerated. It depends very much on
the specific change. Some changes are
based on reasonable evidence; others

are based on flimsy or questionable
evidence, and still others are based on
virtually no evidence at all” (personal
communication, 2013).

The “brain disease” model that currently dominates in psychiatry largely
ignores the complexity of emotional
problems and their frequent anchoring
in real environmental circumstances.
It encourages the development of new
drugs to treat what is often normal
emotional distress in an already overmedicated population. It is based on a
mindset that disregards or minimizes
respect for individual complexity and
difference, marking a dangerous individual, familial, and societal direction.

We, as social workers, as well as all clinicians who are dependent on insurance
companies for reimbursement, know
that these reimbursements will depend
on strict adherence to the DSM-5. We
also know that fewer available sessions
will mean greater dependency on drugs
for a society that is already far too drug
dependent.

Consider these facts: 94% of all individuals in the United States who consult
a mental health professional will visit
with a mental health and substance abuse
social worker, a clinical and counseling
psychologist, a marriage and family therapist, or other mental health or substance
abuse counselors (Grohol, 2011). Yet, for
example, not a single individual with a social work background was on the committee that made the final decisions regarding
diagnostic evaluations.

It is ironic that although the majority
of mental health patients in the United
States have clinicians as their health care

professionals, researchers have come
up with many dangerous and seemingly
arbitrary changes to the newest edition of
the DSM that have no chance of standing the test of time (Frances, 2012). What
we find reflected in the recent DSM is
an emphasis on unnecessary diagnostic
labeling and a reliance on either unnecessary or prolonged medication
and hospitalization. What is missing is
emphasis on working through conflicts
and the clinical support and alternative
healing strategies, including a combined
tincture of time and talk, that provide
solace, lessen pain, and lead to insight
and clarity of thought.

I am in no way saying that medication is all bad, or not to be used in the
short term to feel better and cope, and
when indicated for longer periods. What
I am saying is that drugs are not always
necessary, and long-term medication
should be a very clearly thought out option, not a first and easy one.

We are learning more and more
about serious brain disorders and how to
treat them. The growing science of the
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