In 1952, out of the horrible experiences of WWII, a new system appeared: The Diagnostic and Statistical Manual of Mental Disorders, volume one. It was 192 pages in length and listed approximately 100 disorders. Sixty years later, in 2013, volume five of the DSM came out at 947 pages and 297 specific disorders. Published by the American Psychiatric Association, this handbook is a required tool for anyone working in the area of mental health anywhere in the world. Revised volumes appear when scientific research has shown that changes should be made to match evidence-based treatment. Or as the cynics might report, whenever the APA budget needs an infusion of millions of dollars in cash. In my experience, some of my colleagues use it well, as intended for taxonomic, diagnostic, and treatment purposes. Others learn a few diagnostic numbers to satisfy reimbursement payments from insurance companies.
The DSM-V is essential for quality care in our current health care system and practitioners should know how to use it to enhance their therapeutic skills. In addition, or in an alternative setting, perhaps we could use another (thus dual) diagnostic format, one that dates back to the stones and bones, entrails and excrement. I offer the “DSM-original form”: Diagnosing with Spiritual Material. This form is found in the Torah, book of Genesis, chapters 1-3.
The story of the Garden is intertwined in our cultural teachings; Judaism, Christianity, Islam and in secular literature. We know the basic elements, or at least we think we do. There are at least two stories with significant differences between them; as well as no apple, no snake, and no carrying out of a death sentence. We do remember that Adam (literally “the red dirt creature” or “dust bunny” [check who is coming or going under your furniture]) and his partner are created in a state of health (the image of God) but that changes when they eat of the fruit of the tree of the knowledge of good & evil. Wouldn’t that knowledge be included in the image of God?
Now we have the setting for the diagnostic form. With knowing good and evil, the humans know truth and lie. Adam and Eve have removed themselves from their state of health as indicated when they show embarrassment before God and cover themselves “because they are naked”. They have disjointed themselves from their own sexuality, the image of God, male and female (N.B. “and” not “or”). This is the first diagnostic separation, from self. The second separation is from relationship with others when Adam blames “this woman” for the predicament. Separation from God (#3) comes with the words following “this woman”- THAT YOU GAVE ME! Number four is separation from creation with enmity and toil between humans and the natural world.
The DSM-original form is then: separation from self, from relationship with others, being apart from the Holy Other, and from creation itself. The purpose, goal and process of therapeutic treatment then is to guide people in the healing of those separations. I offer that all of the categories (100 or 300) of the APA DSM will fit in one or more of these original “sins”. Remembering that the word “sin” does not mean bad/evil, but rather is the ancient archery term for an arrow that misses its mark. Therapy is to assist people to learn and grow that they may better hit their mark. May it be so.
[Comments, questions, disagreements, snide remarks, silly stories are invited and welcome – ROB]