Tag: Pastor

Regarding Some Misconceptions Regarding the DSM-5

Introduction

As a professional counselor in training, I have heard and seen some disconcerting assumptions asserted about the Diagnostic and Statistical Manual of Mental Disorders (5th Edition). I have encountered Christian professionals, both counselors and pastors, who argue with some contempt, that the DSM-5 does not offer “Christian” solutions to mental health issues. I use the term “mental health” lightly here, because I know that many pastors and Biblical Counselors reject the idea that there are “actual” mental health problems, preferring to use words like soul problems, human problems, sin problems, martial conflict, and so forth. In any case, this post is dedicated to the making of the DSM-5 and what the DSM-5 is designed to do.

Before I address the history, it is first necessary to recognize what the DSM-5 is designed to do. If a psychologist in Sweden, a licensed counselor in Germany, a medical doctor in Montana, and a psychiatrist in Canada were to sit in a room and discuss particular clients that all share the same symptoms they would use the DSM-5 as a point-of-reference, since the DSM-5 is internationally recognized as a reference and diagnostic tool. For example, a person diagnosed with Post-Traumatic-Stress Disorder from the DSM-5 will have either the same or very similar symptomatology of any other person (regardless of where they are in the world) as long as that other person has also been diagnosed with the DSM-5. They key point that I am trying to get at here, is that the DSM-5 is a diagnostic tool, listing certain sets of criteria that have to be met before someone can receive a particular diagnosis.

History of the DSM-5

The history of the DSM-5 began in 1999, which was initiated by the American Psychological Association (APA). The APA wanted a significant amount of collaboration on this project, so they recruited professionals from many different fields: internationally recognized clinicians, scientific researchers, and professional organizations. “Through this wide scale collaboration, the DSM-5 development process has involved not only psychiatrists, but also experts with backgrounds in psychology, social work, psychiatric nursing, pediatrics, and neurology” (APA, 2013).

A task force was created that included over 160 mental health and medical professionals who were leaders in their fields. From these 160 professionals, 13 work groups were created which comprised over 90 academic and mental institutions around the world. More specifically, within the 160 professionals collaborating on this project: “Nearly 100 are psychiatrists, 47 are psychologists, two are pediatric neurologists and three are statisticians/epidemiologists. In addition, also included are a pediatrician, speech and hearing specialist, social worker, psychiatric nurse and consumer and family representative” (APA, 2013).

In addition to the 160 mental health and professionals who were collaborating on this project, an additional 300 advisors came along side the project to help inform specific areas requiring additional expertise.

The American Psychological Association partnered with the World Health Organization as well as the World Psychiatric Association to help with the organization of the DSM-5. “From 2004-2008, APA, WHO and the National Institutes of Health supported 13 additional conferences involving nearly 400 participants from 39 countries, including 16 developing nations. The work resulted in 10 monographs, hundreds of published articles regarding the current state of knowledge and recommendations for additional research in many fields” (APA, 2013).

Committees also helped in the process, such as the APA Board of Trustees, which overviewed the content for the DSM-5 along with A Scientific Review Committee and A Clinical and Public Health Committee.

Additionally, public feedback was also requested, which brought in about 11,000 comments which impacted changes. Lastly, thousands of additional clinicians and professionals volunteered their time to over up their expertise, contributing to the making of the DSM-5.

Final Remarks

It is important to understand that the DSM-5 is not a “Christian” document. It’s purpose is to function as a diagnostic tool. It is it true that the DSM-5 does not offer Christian advice for how to address mental health issues, however the DSM-5 does not offer any advice on how to treat or medicate mental health issues. It is not designed to do that.

Reference

American Psychological Association (2013). The People Behind the DSM-5. PP 1-2. Click here for page location.

The Body Keeps the Score, A Review

The Body Keeps the Score: Brain, Mind, and Body In The Healing of Trauma written by Bessel van der Kolk systematically demonstrates for the reader why trauma research is valuable, particularly as it relates to the client-counselor relationship.  Van der Kolk begins his book with a historical perspective: As a budding psychologist he recalls his experiences working with Vietnam veterans and their struggles with PTSD.  His observations about the veterans and his curiosity about what causes the symptoms to manifest in the particular ways led him towards a career of helping trauma victims through research, applied neuroscience, and investigating modern psychological approaches to healing those with trauma.

Van der Kolk writes with surprising clarity and humility as he honestly shares his thoughts and concerns regarding his approach to counseling models.  Providing a careful exploration into the science of trauma, Van der Kolk shares many stories and conversations he’s had with clients regarding their trauma which helps to underscore the credibility of each part in his book.  The book is divided into 5 parts: (1) The Rediscovery of Trauma. (2) This is Your Brain on Trauma. (3) The Minds of Children. (4). The Imprint of Trauma. (5) Paths to Recovery.  Additionally, the book has an Appendix entitled: Consensus Proposed Criteria For Developmental Trauma Disorder, which is then followed by a section devoted to resources and further reading.

Throughout his book, van der Kolk frequently references his experience in the medical field which is quite extensive.  He is the founder and director of the Trauma Center in Brookline, Massachusetts, a professor of psychiatry at Boston University, and director of the National Complex Trauma Treatment Network.  In The Body Keeps The Score, van der Kolk shares his life’s work with his readers and it is a worthwhile read for lay readers, students, and professors interested in the subject of trauma and psychology.

Personal Reflection 

I read this book quickly, bouncing between reading the text and listening to the audio version (on occasion doing both), yet taking time to highlight and create notes.  It’s such a dense book that I think I will have to go back and re-read it as some point.  I found the content insightful and certainly feel that I know much more about the symptoms of trauma victims than I did before reading this book.  However, I did find that content of the book disturbing at times, particularly as Van der Kolk recounts, at times, detailed accounts of trauma stories.  Though the stories provide a contextual framework for the book, I think the next time I read it, I will take breaks between the sections to allow myself some breathing space.

My point is that books like The Body Keeps The Score have a great deal to offer the Christianity community, and visa-versa, but until the scientific community is willing to lift the prevailing weapon of relativism it wields against religion, there will remain a gap between religion and science that creates a vacuum and division between the two worlds of counseling practice (pastoral and professional).

However, I have been forever altered in the way I see trauma by reading The Body Keeps the Score, but it makes me sad to think that professional counseling claims science for it’s evidence and in the same breath also claims philosophy (social constructionism) for its explanation for religious diversity.  It seems there must be a middle ground, a way to bring the two groups together without scandalizing truth in the process.

Reading the book has inspired me to continue my studies in trauma treatments, particularly EMDR, yet it has also inspired me to do research into why there seems to be such skepticism amongst Christians regarding psychological and mental health problems and solutions.  As mentioned above, Christians are being told (culturally) that their faith is relative, which may explain some of the push-back Christians have when it comes to psychological explanations for things like anxiety and trauma.  However, there also may be other things at play, such as a lack of education in modern psychology which differs quite a bit from Freudian psycho-analysis.

Conclusion

In The Body Keeps the Score, the reader is invited into a history of how trauma has been viewed and treated over the last fifty years, how trauma impacts the brain and mind, and is provided with a variety of treatments backed by scientific evidence for treating trauma.  The book is filled with many helpful illustrations including brain scans, which are helpful to understand the author’s perspective and well thought-out conclusions about trauma and the inner working functions of the brain.  It is textbook worthy and I look forward to returning to it for further insight and guidance as I move through my professional journey as a counselor and researcher.

References

Van Der Kolk, B. (2015). The body keeps the score: brain, mind, and body in the healing of trauma. NY: Penguin Books.