DSM-5.IRD: An Insurance Reimbursement Disorder
His elegant conception of "the unity and diversity of disorders" offers a penetrating insight into psychological symptoms. Assumed causes and elaborate descriptions of symptoms are interesting, but the perception of purpose is the most helpful therapeutically. Each client, regardless of symptoms similar to others, is unique, striving unconsciously to realize a fantasy compensation for their discouragement. With rare and keen insight, Adler pointed out that every patient has the appropriate thinking, feeling, behavior, and symptoms to pursue his or her unconscious goal. Diagnostically, we are challenged to discover and share that unique portrait with a client so that he or she feels deeply recognized and understood. Adler's construct of the unconscious, fictional, final goal, cannot be measured, but it can be guessed with artistic intuition. Then we must gradually share that insight with a client while we also create a unique therapeutic strategy for helping that individual move in a different direction.
The 360 Procrustean beds of DSM-5 are an insult to the creative uniqueness of individuals. "Evidence based treatment" sounds impressive, but it might be prudent to examine the research more carefully and critically. Recent challenges to the evasive research methods used by pharmaceutical companies should cast a more skeptical light on psychotherapy research motives, methods, and results. Lastly, the potential counter-placebo effect of DSM5 should be explored. Just as many patients have experienced relief from sugar pills, having been unconsciously influenced by their expectations, we cannot rule out the potential of psychiatrists and pharmaceutical companies finding or even inventing a never-ending goldmine of new diagnoses, driven by the expectation of profit.