It is a refrain of mine that skillful humanistic counseling is far too potent to reserve solely for those in a state of crisis. I believe that well timed therapeutic counseling interventions can assist all of us in navigating challenging experiences, find meaning in difficulty, navigate what previously seemed unnavigable and emerge from the experience stronger, wiser, and more connected to ourselves and those around us. And of course, for those suffering from unusually strong, diagnosable mental and emotional distress, psychotherapeutic counseling can likewise be a tool of transformation. But what happens when the human experience itself becomes pathologized?
The newly released DSM-5 (that would be the 5th edition of the Diagnostic and Statistics Manual of Mental Disorders produced by the American Psychiatric Association) has been released and, since January of 2014, is being used by clinicians across the country in diagnosing mental health disorders in the general public.
As per the criteria of the DSM-5, it is believed that about 50% of U.S. Citiznes could be diagnosed as “mentally ill” at some point during their lifetime. Are you experiencing grief at the death of a loved one? Is your child throwing tantrums three or more times per week? Are you over eating? Do you experience PMS? Are you experiencing chronic yet difficult to diagnose pain? An affirmative answer to any of the above can now add you to the ranks of the mentally disordered.
When the common experiences of life (death and loss, sadness, common anxiety, pain etc.) become pathologized, it impacts not only the very functional, yet temporarily distressed person experiencing such, but takes vital resources away from those truly struggling in the depths of unusual mental and emotional malaise.
Dr. Allen Frances—who chaired the task force committee for the previous version of the DSM (the DSM-IV ) and author of Saving Normal: An Insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life states, “Funding for mental healthcare has already been cut in many states, and many people who are mentally ill or even suicidal aren’t getting the help they desperately need.”
Yet the American Psychiatric Association has dismissed DSM-5 opponents as overly alarmed. "All the good epidemiological studies unfortunately show that one in five people have a psychological disorder. ... They're prevalent, they're just all over the place, and that's very disturbing to some people," said Dr. Carl Bell, a Chicago psychiatrist and University of Illinois School of Medicine director of public health and community psychiatry.
However, Dr. Joel Paris, professor of psychiatry at Mcgill University and author of Prescriptions for the Mind: A Critical View of Contemporary Psychiatry counters this view, stating, "The DSM-5, in many ways, reflects the politics of psychiatry these days...Everybody has a kind of investment in certain diagnoses. Those who are studying a particular disorder often are saying, 'Well, this is much more common than you think they are. Oh, the prevalence is very high.' But we risk losing legitimacy because of over-diagnosis...The fact is that most people get by with bad patches in their lives. They recover."
And it is to this sentiment that I turn. All of us will experience emotional challenges and difficulties in our lives. Some more than others. We live in a profoundly fractured and all-too-frequently alienating society. Yet to pathologize the human experience itself strips the very meaning from our lives. It is through challenge and difficulty that character is built and strengths emerge. In extremely challenging situations, supplementation and pharmaceutical medication have their place, I'm not denying it. However, when the common experiences of human life become pathologized, then the meaning of what it is to be human becomes muddy and unclear. And when we are medicated in an effort to insulate ourselves from the common pains of human existence we threaten the very core of what makes us human. The only “winners” of such a zero sum game are those who stand to profit from the over diagnoses of our times.
Being a human being in the 21st century isn't easy. Therapeutic counseling is a tool that can be utilized to assist in moving through the confusion and disquiet of difficult emotional times and a great boon to personal growth and human potential. Never doubt it. But overpathologization need not be a criteria. You are a free, whole and wondrous entity. Never doubt that, either!
I have made the conscious choice not to work with the managed care (ie. insurance) industry in my practice. While sometimes frustrating to new clients, this was not a poorly conceived choice but, rather, a decision made after long and careful deliberation on my part. As we shift into 2014 and the true emergence of the Affordable Care Act, I wanted to take a moment to offer some clarification as to why I have decided not to accept insurance from my clients in favor of a fee-for-service model.
My goal is to assist others in empowering themselves and coming into greater contact with the world around them. I have invested significant time and energy in my training and personal development in order to be the very best I can be at offering my services. Yet, far too often, clinicians working in the managed care system are expected to provide only the minimum of care to clients and to complete treatment in ridiculously short periods of time (at times only being authorizing to conduct six to eight treatment sessions).
In addition, managed care staff often seek extremely detailed and intimate information about clients and the content of psychotherapy sessions in order to approve (or deny) treatment. This information is entered into a computer database, the security of which is beyond my (or my client’s) control. I have deep concerns that this deeply personal and confidential information can easily be available to others within and beyond the managed care organization, shared with other insurance companies, or even sold to (or hacked by) unrelated parties.
Case in point, the federal government and insurance industry has developed a national database of medical and mental health records, in which your managed care records are stored. Regardless of intention or regulation, there is no way to tell how the information from the national data bank will be utilized. I habor concerns that client information could be used for the benefit of health or life insurance companies or employers who are highly interested in any history of information about your health so that they can protect, manage and assure their own future profits and interests.
Most managed care companies do not allow individual clients the freedom to choose their doctor or therapists. Instead, they require you to choose from a list of pre-approved providers. In the realm of psychotherapy such providers often qualify for managed care panels only if they agree to provide short term care (perhaps as short as one to three private sessions), are willing to accept low fees for services, agree to share confidential client information with the managed care entity, and are willing to give up control of clinical decisions to administrators and CEO’s rather than their own skilled judgment.
Because of this, I have chosen to work beyond the bounds of the managed care world. I endeavor to keep my fees as reasonable as possible, in order to provide quality and compassionate services to the men and women of my community.
In decades past, psychotherapy was a deeply creative, at times radical, re-imagining of human well-being, growth and potential. Therapists and clients engaged in a rich dance of vulnerable uncertainty, balancing trust and risk-taking in a creative and idiosyncratic push for change, insight and growth. However today’s therapies are, sadly, far too lacking in such elements. Rich Simon, editor of Psychotherapy Networker notes, “Today's treatment is more and more shaped by predetermined DSM categories and empirically validated, standardized treatment protocols from which deviation isn’t welcomed, if even tolerated. Part of the reason is, of course, that old bugaboo—the power wielded by insurance companies, who eye any treatment approach or idea that strays off the reservation with deep suspicion or outright rejection. But another part of the problem is that we live in cautious times with heightened concerns about HIPAA guidelines and confidentiality, making it much harder to actually see therapists at work who inspire us to push the boundaries of the familiar and show how to engage clients with a spirit of daring and invention."
My practice is dedicated to a reclamation of what therapeutic counseling was, and again could be: A radical, compassionate, growth promoting opportunity for individualized personal change, insight and relief from the alienation and neurosis that sadly plagues our experiences in the modern world free from the dictates of corporate and governmental interests. My clients deserve (and generally demand) no less.
Cheaper Is Not Always Better. Managed care may offer a lower financial cost upfront, but, as outlined above, you may be paying a high price behind the scenes.
Consider Paying Out-Of-Pocket For Your Psychotherapeutic Counseling. Your emotional health and well-being is too valuable to leave in the hands of managed care for-profit companies or governmental agencies. Demand that what you disclose in therapy remains private.
Education. For additional resources, visit the National Coaltion of Mental Health Providers and Consumers at www.thenationalcoalition.org
Bryan Dieterich, MA, LPC