Reversing a decades long trend in mental health care heralded by the publication of the DSM-III, which supports a narrow focus on symptoms and behavior, may seem like an impossible task. The publication of the Psychodynamic Diagnostic Manual (PDM) this winter, however, may well have a far-reaching impact on the way mental health is conceptualized and mental illness is treated.
The creation of the Psychodynamic Diagnostic Manual took several years and the cooperation of a 40-member task force spearheaded by Chairman Stanley Greenspan. To set this monumental work in motion, the heads of the major psychoanalytic organizations agreed to form a steering committee with an international purview, which included Barbara Berger, National Membership Committee on Psychoanalysis in Clinical Social Work; Jaine L. Darwin, Division of Psychoanalysis (39), American Psychological Association; Ruth S. Fischer and Jon Meyer, American Psychoanalytic Association; Stuart G. Shanker, York University; Ronald Turco, American Academy of Psychoanalysis; and Daniel Widlöcher, International Psychoanalytical Association.
Nancy McWilliams and Robert Wallerstein volunteered to serve as associate chairs and, together with Greenspan, worked with the ongoing efforts of five work groups and numerous consultants. In the following phone interview, Greenspan described what inspired this effort and what was involved in bringing psychodynamic practitioners together to form a common cause around creating a complementary system to the DSM and ICD series—one that focuses on the full range, depth, and complexity of mental functioning.
LS: What inspired you to undertake the daunting task of spearheading the creation of a psychodynamic diagnostic manual?
SG: There is a growing trend in the United States, and around the world, to view human functioning in progressively more reductionistic ways. For example, along with the very helpful discovery of the value of medication for certain mental health disorders many years ago, there has been a tendency to try to explain many mental health disorders in strictly biological terms. Advances in neuroscience and cognitive neuroscience have provided valuable insights into how the central nervous system functions, but have led to views of the mind and brain as an organ made up of many modules with insufficient emphasis on the way in which the different components of the brain and mind work together to create the psychological processes that constitute a full human being.
The publication of the Psychodynamic Diagnostic Manual (PDM) this winter, however, may well have a far-reaching impact on the way mental health is conceptualized and mental illness is treated.
The field of depth psychology, of which psychoanalysis has been the most systematic and organized investigative approach, has contributed enormously to our understanding of both the surface and the deeper levels of the human mind. Depth psychology has had an enormous impact, not only on therapeutic practice but also on how we define the very nature of human functioning. Without depth psychological approaches, we would have little understanding of the deeper levels of relationships, feelings, thoughts and fantasies, conflicts, coping, and defensive operations. And yet, in recent years, with the advances in neurobiology and neuroscience, there has been a de-emphasis on these insights. It seemed timely for the major organizations representing depth psychology to work together to systematize current knowledge and emerging advances to rebalance our understanding of human functioning with an appropriate focus on all dimensions of the human mind. We were very fortunate to have many of the leading clinicians and researchers who have made seminal contributions to this knowledge base agree to participate in this collaborative effort and bring it to fruition.
LS: As you note, psychoanalysis has arguably been the most organized of the depth psychologies. At the same time, the history of the psychoanalytic movement has been marked by divisiveness. Can you tell me about the process of bringing together the various professional groups to form the steering committee and various work groups?
SG: Rather than get caught up in the particular language of one or another school of thought, we came at it from the point of view that each theoretical orientation or school of thought was like a microscope where the focus is on a different facet of the phenomena in greater detail. Most theoretical orientations have offered very valuable insights. Problems have arisen when a theory becomes the all-encompassing theory. If we can look at different theories as lenses or microscopes, each one having a relative advantage in looking at one facet of experience, then we can, as we did, use phenomenologically-based descriptions to capture the best insights, even though some of us tend to follow one or another theory.
Lynn Stormon, Ph.D., is a postdoctoral research fellow in the Department of Psychiatry at Upstate Medical University and an adjunct psychologist at Colgate University's Counseling Center. Stormon participated on the PDM steering committee as an APsaA Public Service Psychology Intern.
This effort has been in progress over the last few years through the energy and creativity of the leaders of the major psychoanalytic organizations and a number of their outstanding members. Nancy McWilliams and Bob Wallerstein, associate chairs, have been instrumental in nurturing it along. The presidents of all the main psychoanalytic organizations as the steering committee, and in consultation with their organizations, suggested members for work groups on adult and child disorders, including infancy and early childhood, personality patterns and disorders, profile of mental functioning, and symptom patterns with an emphasis on subjective levels of symptoms. We also formed a work group on research to systematize the empirical basis of the psychodynamic approach. This process has led to the Psychodynamic Diagnostic Manual, also known as the PDM. The expected date of publication is Winter 2005-2006 and people can preorder copies online now ().
LS: What particular groups do you hope to reach?
SG: The PDM is intended to be of help to all professionals and students who practice psychotherapy and psychoanalysis and other mental health professionals and students who are interested in understanding the full range and depth of human functioning. The audience is the entire mental health community.