Below is an important issue, concerning DSM V, in a letter from IAAP - International Association for Analytic Psychology.
Giselle Welter - São Paulo/ Brazil
11 May 2010
Dear Presidents and Individual Members of the IAAP:
I am writing to let you know that the IAAP has made a submission to the DSM V Working Group on Personality Disorders. You may know that DSM IV (Diagnostic and Statistical Manual) is a very influential publication of the American Psychiatric Association used broadly by psychiatrists, psychologists and social workers in formulating diagnoses of mental illness and dysfunction within the community. Its influence is felt beyond the borders of the USA, and its categorizations of mental illness have an important impact on patient diagnosis and treatment in many parts of the world.
Recently John Beebe brought to our attention that the DSM V Working Group, in its revision of DSM IV, is proposing to include the term ‘introversion’ as one of the criteria used to designate the category of ‘schizoid withdrawal’, making it one of the ‘trait domains’ indicative of personality disorder. With John’s help, we formulated a letter to the Working Group to put forward the rationale for not using the term ‘introversion’ in this way. This was forwarded to the Working Group and now appears on the APA website. The deadline for receiving such communications was 20 April 2010.
The IAAP’s response, together with this explanatory email, is being posted on the IAAP’s website in order to to keep you informed about our actions in this matter. As soon as the results of the Working Group’s deliberations are known, which may be towards the end of May, I will write again to inform you of the outcome. I would be pleased if the Presidents of Member Groups would circulate this information to the members of their Societies.
With all my good wishes
Hester Solomon President, IAAP
INTERNATIONAL ASSOCIATION FOR ANALYTICAL PSYCHOLOGY
INTERNATIONALE GESELLSCHAFT FÜR ANALYTISCHE PSYCHOLOGIE
ASSOCIATION INTERNATIONALE DE PSYCHOLOGIE ANALYTIQUE
ASSOCIAZIONE INTERNAZIONALE DI PSICOLOGIA ANALITICA
ASOCIACION INTERNACIONAL DE PSICOLOGIA ANALITICA
IAAP’s President Secretariat Hester Solomon, President
e-mail: email@example.com 12, Kidderpore Gardens
Tel. & fax: 00 39 02 739 5857 London, NW3 7SR, UK
Tel.: 00 44 207 794 7402
8 April , 2010 Andrew E. Skodol, II, M.D.
Research Professor of Psychiatry
University of Arizona College of Medicine President, Sunbelt Collaborative
6340 N. Campbell Avenue, Suite 130 Tucson, AZ 85718, USA
Dear Dr. Skodol,
I am writing on behalf of the International Association for Analytical Psychology to urge that the term introversion not be used to identify the trait domain of personality functioning that can become, if carried to an extreme, a pathological syndrome of reclusiveness, withdrawal, and affective constriction. Introversion, a term introduced into psychiatry by C. G. Jung in 1909, has a long and varied history in personality theory, only a small part of which is captured in Theodore Millon’s otherwise extremely useful discrimination of the syndromes of personality disorder. Millon’s book, Disorders of Personality, has led many American psychiatrists and psychologists to accept the erroneous belief that introversion was simply the historical antecedent to the contemporary conception of schizoid personality disorder. Indeed, if one looks on the DSM-V website for a definition of introversion, one finds this proposed personality trait domain defined in exclusively negative terms: “Withdrawal from other people, ranging from intimate relationships to the world at large; restricted affective experience and expression; limited “hedonic capacity” with trait facets of “social withdrawal,” “social detachment,” “intimacy avoidance,” “restricted affectivity,” and “anhedonia”.
This definition is transparently based on the current DSM-IV diagnostic criteria for Schizoid Personality Disorder, and thus equates introversion with a pattern that has long been regarded as personality pathology. Under the proposed new terminology, the pattern defined as introversion is a trait domain, within a dimensional approach to diagnosis. While this approach does not insist that a personality displaying the trait of introversion is ipso facto pathological, unless the trait dominates the personality to an extreme degree, the clear implication of the definition is that extraversion is the sole basis of positive affectivity and healthy relationships with others. We believe this unjustified conclusion stems from the misuse of “introversion” as a term to represent a trait domain of detachment from social relationship and one’s own affects.
For many of us, the term “introversion” means the normal and psychologically essential process of introspection and reflection through which people define, evaluate, identify, and digest both outer and inner experience. Encouraging mental health professionals evaluating personality to write and think about introversion in negative terms would be analogous to asking internists evaluating patients to view inhaling with suspicion, because it is a compromise or absence of exhaling.
The International Association for Analytical Psychology represents approximately 3000 member analysts in 50 Institutes of Jungian Analysis around the world, and their influence is sufficiently felt through teaching, supervision, publication, and, of course, clinical work, to bring us in contact with many mental health practitioners who are working closely in psychotherapy with patients who happen to be introverted. It is clear to us that patients who need to connect positively with their inner lives will suffer if the very word "introversion," which has been a lifeline to many, becomes stigmatized as it would under the proposed DSM-V wording.
I want to thank you for letting us give input as part of your own hard work to get this right.
Hester Solomon President, IAAP