Although this will certainly take a little bit of time, the end of the DSM, and the categorical approach in general, has begun. Several signals suggest this.
To begin, there was the denunciation of numerous ﬂaws in the diagnostic approach. A lot of attention has been brought to the lack of innovation in the latest version, the DSM-5, where many awaited a paradigm shift, precisely because of these major flaws. And then, the divergences were such within the task force that drafted this latest version, with many resignations, that it is clear that the DSM must radically change, or it will disappear…
What will be the alternative? Perhaps a transdiagnostic approach. The U.S. National Institute of Mental Health (NIMH) has begun to encourage it – mainly for biological factors, but at least it is a start – through the RDoC project. We are also moving in this direction, for psychological processes this time, through the functional transdiagnostic approach. It will allow the development of more effective therapies, through process-based behavioral and cognitive therapies (read in particular this founding article by Stefan Hofmann and Steven Hayes and this book, to which I had the chance to contribute).
In the meantime, more and more of us are coming to the conclusion that the symptoms described in the DSM and ICD are not, in fact, the principal problems of our patients.
From an ACT perspective, For ACT, psychological disorders are about not focusing on what is important to you (the lack of action towards values) because you are too busy trying to get rid of what hurts you psychologically (the loss of psychological flexibility towards experiential avoidance). These are the symptoms that ACT targets. In fact, they are the only symptoms that ACT targets. In fact, they are even the only symptoms according to ACT.
In this way of considering psychological disorders, what causes the most suffering in the end is to be deprived of what matters most to us, of what seems essential to us, that is to say, to be deprived of our essence, in both senses of the word: what constitutes us, as well as our fuel for action. So, logically, the ultimate therapeutic goal of an ACT therapist is to help his or her patients regain the strength to act towards what matters to them, so that they can live in coherence with who they know they are.
As a result, in my DSM, there would essentially be entries such as:
No longer explores
No longer learns
No longer connects with others
Has nobody to take care of
Can no longer contribute
No longer has the possibility to convey
No longer creates
No longer shares
in addition to all of the other sources of fulﬁllment of which we think we are denied, that which we have lost sight of or neglected.
My DSM would be much shorter, that’s for sure, as each and every one of us vibrate and suffer from nearly the same things. Would it be less useful? Or, on the contrary, would it help therapists and patients to focus on what really makes sense, rather than trying to fight the banality of evil?
Translated by Chelsea Davis-Laurin
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