Sheila K. Collins Website



May 2013  

Masthead Sheila K. Collins from Website

Something from my past has captured my attention this month - the release of the new version of the mental health "bible," the "Diagnostic and Statistical Manual-5". As a therapist for the past thirty years this manual has been on my desk, and referenced often in filling out paper work and blank spaces in medical charts. Let me know your take on this cultural practice of how we name disease.

May has been a busy month with advance planning for my book launch in August. Thanks to my daughter-in-law Jody Curtis, the book now has it's own web page - Check it out. 


And finally, another project is ready for launch - the InterPlay Proof Project that Pam Meadowcroft and I have been working on this past year. We are poised to systematically collect data on the effects of InterPlay, moving us toward becoming an evidence-informed system. You can help in a special way by making a contribution to InterPlay on Give InterPlay Day Wednesday May 29. 

Thanks for your support,


Sheila Collins Sheila

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Upcoming Events

Wednesday May 15, 2013  

Death, grief and the end of life, have been major themes in my life recently. Last week a 23 year-old man collapsed at the Pittsburgh Marathon and became its first casualty. Friends and family were shocked, there had been no personal or family history to indicate his risk, and the story became international news.



Tuesday May 7, 2013 

It was a trek, as all spiritual journeys are, with five of us traveling six hours from Pittsburgh in my SUV. The Serpent Mound is in southern Ohio, not far from Cincinnati and my friend Vikki Hanchin's recent book, The Seer and the Sayer told of her experiences there. 



Saturday April 27, 2013

Until a month ago, if you'd asked me if I consider myself a flexible person I would have said yes. In face, on some occasions I may have been too flexible, putting up with things longer than I probably should have. But there's nothing like a construction project in your home space to test whatever good qualities you thought you had.


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Be Careful In The Naming


Though I'd rather see a catalog of the symptoms of wellness, the mental health field continues to keep its focus on disease this month by releasing a new version of its mental health "bible," the Diagnostic and Statistical Manual-5. Used by all behavioral healthcare professionals in the United States, the manual is revised every 15 or so years after much debate, DSM-5 research, and field-testing. The purpose of the volume is to establish a common language for medical specialists as they work on behalf of clients, and for researchers comparing results study to study. But for the general pubic the practical reality involves the third party reimbursements many people count on to pay for their treatment.


As a "psychiatric social worker," and a university instructor of various types of family therapies over these past thirty years, I've seen each version of the manual be strongly influenced by the types of treatments available at the time, (lobotomy, electroshock, drugs, psychotherapy), the scientific breakthroughs in understanding the body and the brain, (brain imaging, behavioral outcome research) and the cultural biases of each decade.


  cartoon of cloud At the University Health Center where I worked in the 70s, the stigma associated with mental illness had students experiencing headaches praying for a brain tumor so there would be a physical reason for their symptoms. This same stigma keeps some people from seeking treatment, even today. But culture and attitudes do change and with them, the list of diseases. Thankfully homosexuality is no longer considered a disease, and the lack of control over one's drinking earns an addiction diagnosis today rather than a moral judgment on one's character.


When the first volume was published in 1952, followed by the second in 1968, Freudian psychotherapy was in vogue. The operating principle then, according to Rick Mayer and Allan V. Horwitz was that "overt symptoms did not reveal disease entities but disguised underlying conflicts that could not be expressed directly." By the time the DSM III came along in the early 80's with a revision in 1987, a school of thought had emerged that objected to categories of diseases.

Karl Menninger 
Karl Menninger
As the psychiatrist Karl Menninger 
expressed it, "All mental disorders are reducible to one basic psychosocial process: the failure of the suffering individual to adapt to his or her environment."


Working with families from different cultural backgrounds, I came to see the great danger in separating out an individual and their symptoms from the milieu in which they live. My gay son had trouble coming out publically about his sexual orientation and later about the disease he contracted due to the attitudes of the larger culture at the time. Family therapist Virginia Satir's suggestion - "In what situation would this attitude or behavior make sense? When you see someone who seems to be crazy, look in the system for who or what might be driving them crazy." 


The upcoming fifth revision replaces the DSM IV, first published in 1994, and will, as earlier versions did, make changes in what is or is not considered a disease. Early reports warn that the term "dementia" is being eliminated, replaced by "mild Neuro-cognitive Impairment." "Binge Eating Disorder" has moved from the appendix to the main section of Eating Disorders, sharing space with "Anorexia Nervosa." And in the Major Depressive Disorder category, the "bereavement exclusion" has been eliminated which makes me more than a little nervous. This exception was a two-month pass after a major loss before a person with severe symptoms would be labeled with a psychiatric disorder. (Susan Krauss Whitbourne, Psychology Today). 


So with each revision there is fear that some changes may make what's normal seem sick, or as with ADHD, that by emphasizing biological causes people will be lead to medicine rather than to more effective behavioral strategies. My hope is that this carefully thought system of naming will serve to organize and structure treatment, while not isolating and stigmatizing the people exhibiting symptoms.
Virginia Satir: Becoming More Fully Human  
Virginia Satir: Becoming More Fully Human
Paula J. Caplan: Losing Labels to Find Ourselves 
Paula J. Caplan: Losing Labels to Find Ourselves
Sheila K. Collins, PhD 

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