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The Humanistic Psychologist

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Humanizing Mental Health:

Existentialism and the DSM-5: Can
Humanistic Psychology Light the Way?
a
Donna Rockwell
a
Michigan School of Professional Psychology
Published online: 29 May 2012.

To cite this article: Donna Rockwell (2012) Humanizing Mental Health: Existentialism and the
DSM-5: Can Humanistic Psychology Light the Way?, The Humanistic Psychologist, 40:2, 207-211, DOI:
10.1080/08873267.2012.672258

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 The Humanistic Psychologist, 40: 207211, 2012
Copyright Division 32 (Humanistic Psychology) of the American Psychological Association
ISSN: 0887-3267 print/1547-3333 online
DOI: 10.1080/08873267.2012.672258

COMMENTARY

Humanizing Mental Health: Existentialism and the DSM-5

Can Humanistic Psychology Light the Way?
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Donna Rockwell
Michigan School of Professional Psychology

What is the link between existentialism and a manual that gives most people on the planet their
mental health diagnoses? From Major Depressive Disorder, to ADHD, to Aspergers Syndrome, the
Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) is
the book in which psychiatrists, psychologists, and other mental health professionals find the codes
needed that allow insurance companies to cover the treatments provided. Sad to say, these labels
often become the identity by which many people come to see themselves for the rest of their lives.
Humanizing mental health treatment has been a long time in coming. In other words, its high
time that focus be turned to more humane approaches to healthcare treatment, in mental health
fields, and beyond. The field of psychotherapy, which helps those who: (a) suffer from emotional
pain; (b) find challenges to daily living in work, love or play; or (c) are experiencing blocks to
self-actualizing, has a jaded history in its attempt to stay true to its most important edict to do no
harm. Our field could really use a wake-up call: from the early botched lobotomies, to opening-
and-then-closing of thousands of mental hospitals leaving countless troubled souls to live on the
streets, to modern-day psychiatric excesses of overdiagnosis and overreliance on pharmacologi-
cal approaches to solving what are often existential problems, and reducing human feelings to
biological etiologies. In these less-than-humanistically-based approaches, mental health treat-
ment loses sight of the person-centered aspects of the problem, in which (wouldnt you know it)
the true healing lies.
With global and economic upheaval pushing people (and institutions) to the edge, perhaps the
time is ripe for a new era of humanistic psychology to infuse every field thats interested with
awareness of existential humanistic values of self-responsibility, unconditional regard, and

This commentary is based on a blog that was originally posted on The New Existentialists: www.newexistenitalists.com
at www.saybrook.edu.
Correspondence should be addressed to Donna Rockwell. E-mail: Drdonnarockwell@yahoo.com
 208ROCKWELL

empathic engagement, woven, with intentionality, into internal institutional templates and
approaches to corporate culture. It could make a world of difference in work-life meaning, con-
tributing to workplace happiness and productiveness.
So many people the world over are suffering from a form of existential whiplash from the
economic tumult and personal loss of an identifiable being-in-the-world that makes ego syntonic
sense to them. Lost jobs; economic hardship; familial collapse; loss of home, hearth, and hope
such existential crises cannot be fixed by pills alone. The current controversy over proposed new
diagnoses in the upcoming DSM-5 has psychologists and mental health professionals deeply
concerned, as they see so many of these struggling people identified as mentally ill, given a diag-
nostic number, and treated with a cocktail of prescribed medicines that dont come close to
addressing what is really wrong. Speaking out against what they see as the dehumanizing of
psychological care through overmedicalization and overdiagnosis of vulnerable populations of
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children and the elderly in particular (but touching the lives of the general public, as well),
through revolt against the proposed DSM-5, the mental health community is shouting a resound-
ing, No! Last fall, within months, more than 10,000 mental health professionals, organizations,
international psychological groups, and others, had signed an online open letter petition asking
the DSM-5 Task Force and the American Psychiatric Association to show greater transparency in
their process of vetting some of the more controversial new diagnostic criteria (http://www.ipeti-
tions.com/petition/dsm5/). News media outlets and bloggers were quick to tell this David and
Goliath story of the foot soldiers who see the impact of misdiagnosis and the harm of overmedi-
cation, and are standing up to the giant psychiatric publishing monolith as it moves the DSM-5
each day closer to press (it is due to close its review process this summer, and be published in
May 2013).
To ensure safe and sound mental health diagnosis of the American public and, increasingly,
those in other cultures around the world, the DSM-5 must be bound and published only after its
contents have been conceived and executed in a scientifically-based and transparent way. In the
name of the professional psychological community, The Division 32 Open Letter Committee
wrote a follow-up letter to the DSM-5 Task Force on January 9, asking for their pleas for transpar-
ency to be addressed. (http://dsm5-reform.com/the-open-letter-committee-calls-for-independent-
review-of-dsm-5/ )
The response came from John Oldham, MD, President of the American Psychiatric Association,
on January 27. Dr. Oldham dismissed concerns raised by the Open Letter Committee and others
in the mental health field by writing, There is in fact no outside organization that has the capac-
ity to replicate the range of expertise that DSM-5 has assembled over the past decade to review
diagnostic criteria for mental disorders (Oldham, 2012, para. 3). Leaving behind the cries of the
psychological community, the DSM-5 authors pushed on.
Some worrisome new diagnoses include Attenuated Psychosis Syndrome where, by trying to
identify psychotic tendencies early and preventatively, a diagnostic net is cast so wide that quirky
or eccentric teenagers, in so-defined outlying stages through which many adolescents pass, may
be mislabeled with APS. Another new mental disorder of concern is Disruptive Mood Disregulation
Disorder for children and adolescents, allowing for kids who are acting out to end up with long-
lasting diagnostic labels. Similarly, Major Depressive Disorder, which in the DSM-IV used a
bereavement exclusion to acknowledge the normal and natural grief process after the loss of a
loved one lasting up to two months before MDD could be diagnosed, is shockingly, in the new
DSM-5, shortened to a mere two weeks. Proper medication can still be prescribed without the
 EXISTENTIALISM AND THE DSM-5209

need for a life-long diagnosis of MDD, a mental illness, hanging like an insurance albatross
around the unsuspecting persons neck. The proposed diagnosis of Mild Neurocognitive Disorder
for elderly patients could easily lead to overmedication of this already oversedated population,
especially those who live in nursing homes. And, reportedly, Aspergers Syndrome, describing
those with a high-functioning intellectual level of Autism who often have an intense, keen, spe-
cial interest in which many could be considered gifted, is disappearing, and simply becoming
part of the autistic spectrum, along with other changes to diagnostic criteria garnering attention
from national media outlets like The New York Times, Time Magazine, Bloomberg, NBC and
ABC News. International coverage of the DSM-5 controversy includes stories in Reuters, The
Guardian, and The Independent, among others.
The overdrugging of nursing home residents, as well as foster children (who are prescribed
antipsychotic drugs at a rate five times that of nonfoster children), have been hot topics in the
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news lately, including testimony on Capitol Hill by a 12-year-old foster child on his life altering
experience on psychotropic medication. Meanwhile, the unprecedented increase in the diagnosis
of ADHD has led to a widespread shortage in attention-hyperactivity medicine for those who
actually need it. It is these vulnerable populations whose existential realities are most at risk.
Who speaks for these people? Who makes sure there is no harm done? In the name of humanity,
and an intersubjective revelry that makes clear that if I-am-not-for-you and you-are-not-for-me
there is no real hope, who is in charge of watching the henhouse and speaking up for the voice-
less? We would be well served to see the truth of our interdependence, and figure out how to
achieve the healing we are after from that place.
Social medias town square, Twitter, speaks to the overdiagnosis/overmedication issue from
many corners of the globe. One tweet, from @metroidbaby, ironically stated: Oh boy the new
DSM-5 is gonna have all sorts of exciting new disorders for me to get diagnosed with! (January
12, 2012 9:29 PM)
Recent scientific studies also highlight the problematic nature of overdiagnosis and overpre-
scription of antipsychotic medication:
Antipsychotics and Mortality in Dementia (Corbett & Ballard, 2012) looks into the
use of powerful antipsychotic drugs in the elderly population, in which the authors
report that a series of lawsuits and settlements suggests that many pharmaceutical
companies have improperly promoted these drugs to doctors and nursing homes for
many years.
APA Responds to Reports on Antipsychotic Prescribing (Wolfe, 2012), in which new
research on alleged overuse of psychotropic medications in both nursing-home and
foster-care settings signals a need for better training of nonpsychiatric physicians and
increased funding to bolster the mental health workforce, according to American
Psychiatric Association in recently submitted congressional testimony (p. 7).
Senators Proposal on Antipsychotics Generates AMA Opposition (Moran, 2011), in
which the [American Medical Association] opposes a proposal requiring physicians
who use atypical antipsychotics and other medications with black-box warnings for
off-label purposes to certify in writing that the use meets certain government
requirements (p. 1b).
And, most recently, after being taken to court by the state of Texas, the drug maker, Johnson &
Johnson, agreed to a payout of $158 million in a case involving the improper marketing of the
 210ROCKWELL

antipsychotic drug Risperdal to children, and others in the states Medicaid program, after FDA
warnings against doing so.
Through first-hand accounts from the trenches, the alarm bells are sounding throughout the
psychological and mental health communities, warning of the harm done by psychiatric false
positives and psycho-pharmacological overkill, as well as pointing to recent scientific research
findings that stress the real-world experiences of overmedicated patients, among them children
and the elderly. This may well be the existential issue of our time: how to foster a willingness to
presence humanistic engagement with ones own personal phenomenology.
Visiting with a girlfriend recently over Sunday brunch in Old Town Alexandria, Virginia,
down the road from the DSM-5 Task Force offices, she told me the story of her daughter, a
21-year-old college student who was nervous about exams. With her family of origin comprising
an older sister heading to medical school, and two accomplished lawyer parents, the girl sought
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out a therapist off campus. Calling home after the session, she reported to her mother that after
she told the therapist her story, the first suggestion was that she get a prescription for Wellbutrin,
the antidepressant medication. As it turned out, my friends daughter never filled the prescription;
she said just talking about it made her feel better.
If we invite our clients to run to the medicine cabinet every time they feel psychic or emotional
pain, we are taking the short cut: but to where? We end up doing a disservice to the people we are
chartered to serve. If the key factor in successful psychotherapy is the alliance between the patient
and the therapist, as reported in Wampold (2001), it is our job, through the relationship, to help
clients face the existential stuff of their lives directly, and discern ways to reenter the path to
personal growth and development. Therapists act as guides in the therapeutic encounter, becom-
ing, as it is, the relational metaphor for our clients waltz with life itself. It is not Pollyanna to talk
about therapy in this way; it is existential truth.
As gatekeepers to a field vulnerable to decisions based on pharmaceutical industry influence,
it is up to all mental health professionals to stand for the public trust and ensure the proper,
uncorrupted distribution of mental health services, and consideration therein of the personhood
of each and every consumer of the product we marketwhich is a personal reorientation to
ones self-actualizing tendency, humanistic connection as therapeutic change agent, and an hon-
oring of the individual nature of each persons being-in-the-world. We need to be careful not to
unintentionally lobotomize the human race through the overprescription of unneeded and down-
right dangerous medications, through financially driven trends in diagnosing and prescribing.
Only through a person-centered, humanistic approach can the being-based or ontological reali-
ties of the person-in-therapy, as well as the therapist, enter the room as valuable stepping-stones
to well-being.

REFERENCES

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision).
Washington, DC: Author.
Corbett, A., & Ballard, C. (2012). Antipsychotics and mortality in dementia. American Journal of Psychiatry, 169(1), 79.
Moran, M. (2011, December 16). Senators proposal on antipsychotics generates AMA opposition. Psychiatric News,
46(24), 1b28.
Oldham, J. (2012, January 27). Response letter to the Society for Humanistic Psychology. Retrieved from http://www.
dsm5.org/Newsroom/Documents/Society%20Humanistic%20Psych%20Response_012712%20final.pdf
 EXISTENTIALISM AND THE DSM-5211

Wampold, B. (2001). The great psychotherapy debate: Models, methods, and findings. Mahwah, NJ: Routledge.
Wolfe, J. (2012, January 6). APA cites a need to use practice guidelines when prescribing antipsychotics in nursing homes
and foster-care facilities. Psychiatric News, 47(1), 7.

AUTHOR NOTE

Donna Rockwell, Psy.D., is a member of the Division 32 Open Letter Committee, leading the movement to reform
the DSM-5 (dsm5-reform.com), is member-at-large of the Society for Humanistic Psychology, and co-editor of the SHP
Newsletter. She is associate faculty at the Michigan School of Professional Psychology, a clinical psychologist in private
practice, a columnist for Ambassador Magazine in her regular feature, Being & Becoming, and is the mental health con-
tributor on WDIV-TV.
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