Attention Merchants, Self Diagnosis, DSM Critique, and VSNT Conference

“Whoever you are, no matter how lonely, the world offers itself to your imagination, calls to you like the wild geese, harsh and exciting – over and over announcing your place in the family of things.”

— Mary Oliver, Wild Geese

Hello Everyone. Whew! It’s been a fast-paced start to the new year for the Vancouver School and my-oh-my it feels good to be back with all of you. Many thanks for stopping by.

This month’s narrative newsletter offers a few reflections on 1) Social media attention merchants, 2) Recent rise in self-diagnosis, 3) Remembering the insider DSM diagnosis critique.

I haven’t listed these topics with any particular reading order in mind so – please feel free to peruse them in whatever way you like: 3-1-2, or 2-3-1 etc. The hope is you’ll draw your own connections and conclusions (if in fact there are any to be made). Ha!

The March 2025 narrative newsletter answers the long-awaited question of exactly when and in what city our next Therapeutic Conversations conference (this makes it #23!) will take place, and – tells the story behind how the decision was made and who was involved.

OK let’s begin our little newsletter chat . . . with a short verse entitled Introduction to Poetry - written by former American Poet Laureate Billy Collins:

"I ask them to take a poem and hold it up to the light like a color slide or press and ear against its hive. I say drop a mouse into a poem and watch him probe his way our or walk inside the poem's room and feel the walls for a light switch. I want them to waterski across the surface of a poem waving at the author's name on the shore. But all they want to do is tie the poem to a chair with rope and torture a confession out of it. They begin beating it with a hose to find out what it really means."

Since this new year began, I’ve been speaking with a wide range of academics, therapists, and artists around the world (who are all friends) regarding what’s capturing their interest and consuming their attention.

Politics, climate, music, family, and books they’re reading always come up, however, over this last while, a newfound topic prospect emerged. 

Near the top of this month's hit parade were discussions on the variance between aesthetic and scientific ways of viewing lives and relationships that our illustrious poet laureate above points to.

Our chats involved how (*not all psychology) - but certainly internal state popular psychology - individualizing/essentializing ideas like self-realization, self-fulfillment, self-actualization, etc. The ideas of the autonomous skin bound isolated individual self seem to be popping up just about everywhere we look - and play directly into the neoliberal political handbook (during our Foundations of narrative therapy training last weekend, VSNT philosopher in residence Todd May discussed his new ideas on how we are entering a post-neoliberal world – a move from viewing the individual as entrepreneur - towards organizing the person-as-obedient subject and - we’ll save this analysis for another time).

Most stunning (or perhaps exhausting) is how individualism, despite decades long critiques from a wide array of disciplines, continues to get a ‘pass’.  A dire consequence of individualism going unchecked is how it has become a unifying discourse within popularized mental health practice and the public's problem-centred vocabulary of the self. 

Friends I speak with refer to the phenomenon as . . .  ‘A stunning homogenization’ and ‘a difficult to find discernible differences between’ 1) popular psychotherapy practice, 2) self-help literature and, 3) the wellness industry. Another stated: ‘The trifecta is becoming one big happy self-blaming family’. Ha! 

Binding this trifecta together includes: championing ideas regarding the concept of an individual ‘core self’; a turning away from cultural/social We responsibility/interconnectivity to an all-about-Me consciousness; hyper-focus attachment on diagnosing the cause and underlying deficit structure of individuals (through medicalizing language); espousing taken for granted universal attachment styles, medicalizing normalcy; believing problems, trauma, and sufferings stem primarily from how adults were treated as children; and copious amounts of expert advice (often white middle-class) doled out to clients/public by self-defined expert therapists/self-help writers/wellness pundits.

"Relationship is not internal to the single person. It is nonsense to talk about 'dependency' or 'aggressiveness' or 'pride' and so on. All such words have heir roots in what happens between persons, not in some something-or-other inside a person" (Bateson, 1979, p. 133)

Historically, what seemed to help psychotherapy separate from individualism was a serious questioning of individualism’s key constructs through advances in cybernetic and systemic theories (about 65 years ago).

The revolution and push back of individualist ideas began through the field of family therapy with Bowen, Minuchin, Milton Erickson, Bateson+MRI (Jackson, Weakland, Haley etc.), Milan Team (Boscolo and Cechin), Lynn Hoffman, Virginia Satir, Ackerman Institute (Goldner, LaPierre, Penn, Papp), Goolishian, Karl Tomm, Ken and Mary Gergen, etc., etc. - and I’m happy to list a few dozen more brilliant systemic oriented therapists and thinkers to this list (:E

Emerging out of Family Therapy’s systemic rebellion came even more strident non-individualist traditions of psychotherapy and philosophy.

These include the emergence of formidable post-modern, post-structural , and cultural studies informed therapists like: Nolliag Byrne and Imelda McCarthy in Ireland, Alan Wade in Canada, Allan Jenkins in Australia, Gail Simon in England, Ken Hardy/Harlene Anderson in America, Marilene Grandesso in Brazil, Johnella Byrd and John Winslade in New Zealand, Jaakko Seikkula in Finland, and Rolf Sundet to Tom Andersen in Norway – and again, the list goes on . . . and includes Michael White and a slew of narrative therapists (in support of a non-individualist post-structurally informed theoretical base at the centre of their practice ecology).

And then of course there is a brilliant range of multidisciplinary theorists that inform non-individualist practices of therapy like: Michel Foucault, Judith Butler, Gilles Deleuze, Julia Kristeva, Jack Halberstan, Barbra Myerhoff, Clifford Gertz, W. E. B. Du Bois, Franz Fannon, Donna Haraway, AnaLouise Keating, Stuart Hall, to name a few and once again – this list goes on and on.

I suppose the cynic might read what I’ve written so far as a longing for nostalgia and/or a desire to make ‘psychotherapy great again’ (Ha!).

But no – it’s my simple way of offering an invitation for us to consider the merits of our hard-fought non-individualist common practice ground and possibly engage and discuss our practice together, concerning: what we say we stand for regarding the politics of identity through sets of non-individualist relational/cultural/socio-economic and political considerations (class, gender, race, sexualities, structural inequalities etc.), or perhaps how the subject – the ‘I’ - can never be disembodied from the cultural, political, and relational context we are shaped by, imbedded within, and live through.

I suppose another point of writing about this short history of the present is to raise a few questions/considerations: 

• Is it important to honour the generations of systemic and non-individualist minded therapists and thinkers that came before us? 

• What are the consequences (to therapists and clients) if the field of psychotherapy allows decades of non-individualist ideas to be side-lined and eventually - slip away?  

• Do we each share an equal responsibility to raise these questions?

My invitation for us to participate in community discussion brings me to the shores of an exciting announcement.

Therapeutic Conversations Conference 23

October 8-11, 2025

California

Quick story: Three short weeks after our Therapeutic Conversations 22 conference ended in Vancouver (November 7-9, 2024), I wrote to the heads of the California narrative therapy clans. All my email stated in the subject box was, “I have an idea (:” - and offered a zoom time. 

All the California narrative clans showed up. 

The ‘idea’ was simple: three years had passed and perhaps now it was time (again!) to host the Vancouver School’s annual Therapeutic Conversations conference outside of Canada. 

I wondered aloud if they (the Californians) were interested in hosting. 

Big grins and enthusiastic ‘yeses’ followed - looking a lot like, a) they’d either been waiting on the asking, or b) the idea made so much good sense so as to not turn it down. 

Whatever it was, a plan and City location was hatched in a matter of minutes. 

No fuss, no bother. Let’s get to it . . . California here we come.

The first narrative clan to volunteer and co-host TC23 in October 2025 was Jan Ewing and her longstanding Narrative Initiatives San Diego (NISD) non-profit society (you may remember how Jan and her NISD group hosted the last workshop Michael White ever spoke at back in April 2008). 

On the 16th of December 2024, the Californians and I presented the new San Diego conference location to all the TC22 conference presenters – who’d earlier decided to continue our Zoom presenter gatherings (post conference) and discuss narrative practice ideas and new developments, together. 

The presenter group immediately began plastering the walls with new conference ideas regarding topics, structure, intention, purpose, and feel. 

Our meeting reminded me of the principle of emergence: how a multitude of any number of living things – neurons, bacteria, ants – can exhibit properties way beyond the capability of any one individual. And just like that (!), this bright-eyed group of committed veteran narrative therapy practitioners became far greater than the sum of our individual parts.

TC23 Conference Update: As much as Jan and the NISD group tried (over the course of 7 weeks! and contacting 30+ local venues), they unfortunately could not secure a conference site. There will always be next year! (:So now, it is VSNT’s great pleasure to announce (drumroll please):

The Vancouver School for Narrative Therapy will co-host Therapeutic Conversations 23, in Sacramento, California.

October 8-11, 2025.

YES!!  – VSNT will (once again) be working alongside David Rock Nylund, Abby Walker and their massively diverse, super bright, super progressive, super skilled, and super fun - Sacramento based narrative therapy community. Certain to be a Therapeutic Conversations conference for the ages.

Many other narrative therapy clans across California, America, Canada, Europe, Hong Kong, Down Under, Scandinavia have (already) reached out to add their fair share of excitement and - we invite all of you to do the same.

Please don’t hold me to this but . . .  I believe what’s developing is the creation of a splendidly forward thinking multi-generational presenter/participant conference highlighting, discussing, and debating emerging ideas; opening up the narrative tent through round table discussions (as TC conferences are historically known for), a section of short-form 30 minute ‘trying-out-ideas’ presentations; inviting keynotes in from other disciplines; and all workshop presenters working together months beforehand to re-think how to best demonstrate the agony, complexity, and pure ecstasy involved with narrative practice skill.

And yes (of course), the conference will be filled to the brim with live narrative therapy practice and relational supervision demonstrations.

In the coming weeks, TC23 will broadcast a general call for workshop proposals and, for the time being, we believe we’ll be looking at 60-minute keynotes, 2.5-hour workshop presentations, as well as 30-minute brief talks, as well as round table discussions.

THERAPEUTIC CONVERSATIONS 23 CONFERENCE

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And now onto the next bit...

1) Remembering APA insider DSM critique

Tom Insel - the director of (America’s) National Institutes of Mental Health (NIMH), as the Diagnostic and Statistical Manual of Mental Disorders (DSM–5 went to print) wrote that - there is no consensus on whether such disorders are biological in nature. This statement from the NIMH had the effect of rendering DSM–5 stillborn as a research language.

In addition, the diagnostic manual’s 5th version concerned the editor of the DSM–IV enough - to come out publicly against it. In his scathing book entitled Saving Normal, Allen Frances (who had Chaired the DSM-IV revision), that due to DSM-5's changes: ‘Many millions of people with normal grief, gluttony, distractibility, worries, reactions to stress, the temper tantrums of childhood, the forgetting of old age and ‘behavioral addictions’ will soon be mislabeled as psychiatrically sick…’.

The fifth edition of the American Psychiatric Association's DSM-5 has also been criticized for its revision process, goals and content. The most vehement and sustained objections were aimed at the content of its diagnostic criteria.

It was argued that the revised criteria illegitimately expanded psychiatric diagnosis into areas of:

a) normal-range distress and other problems in living, 

b) undermining the integrity of psychiatry as a medical discipline, 

c) obscuring the meaning of its research results and potentially leading to unwarranted and possibly harmful treatment. 

This ‘false positives problem’ of mis-labelling normal condition as mental disorders - is the issue that most impacts psychiatric epidemiology, given its heavy reliance on DSM criteria in community studies. 

Most egregiously, the deliberations of the DSM-5 Scientific Review Committee, formed in response to the DSM-5 controversies to evaluate the strength of the scientific evidence for each proposed change and provide recommendations to the workgroups, were being kept strictly secret. In short, the greatest obstacle to ‘scientific progress’ was, and has been, the DSM system of diagnosis. In 1980, DSM‐III promised to push psychiatry forward, defining clear criteria for improvement with research. Now, your DSM‐5 is based on unscientific definitions which the profession's leadership refuses to change based on scientific research.

Perhaps most important to consider is the fact that upon the USA’s National Institute of Mental Health (NIMH) leadership's strong criticism of the DSM‐5 upon its publication - it later announced it would no longer fund research using DSM criteria!!

2) Social media attention merchants 

Attention shoppers! The irony of writing about the commodification of attention (brought to my attention by my good friend Todd May), is that I am now vying for your attention (:

OK: Let’s begin with William James. In his book Principles of Psychology (1890), he wrote how his lived experience is indelibly shaped by “what I agree to attend to”. 

James suggests that we cannot not attend to something as something is always being attended to - as something, or someone, always draws our attention forward. 

For example, currently 64% of the world’s 8 billion human population spend an average daily time of 143 minutes attending to social media. 

On January 20th of this new year 2025, I made a point of staying away from my TV and not giving any attention to (small act of protest) the US presidential inauguration. Until I didn’t, stay away. 

When I clicked on the set there was a close-up shot of Amazon CEO Jeff Bezos, Meta CEO Mark Zuckerberg, Google CEO Sundar Pichai, Apple CEO Tim Cook, and TikTok CEO Shou Zi Chew - standing on the dais. Together. 

Sitting in the seats of honour. Closest to the ring of power. The world’s largest U.S. tech firms all in a row. An easy relational read of the group (and the name the broadcast pundits gave them) was, billionaire tech bros. A more fetching analysis might be attention merchants.

This particular attention merchant grouping represents the largest corporations in the history of humanity who spend billions upon billions to find out what the public craves. The reason they so aggressively compete in the attention merchant Olympics is to rise to the top of our search results. The gold medal prize, purpose, and profit motive are to see who can best hold onto the public’s attentional space most, and for as long as possible. 

The specific content, information, and learning is not often at the heart of the competition. Similarly, the specific content, information, and learning is far less important to the commodification of attention itself. These are attention and logistics companies and, the products themselves are an afterthought.

To make this a bit more personal - there are probably very few among us who have not had a household quarrel (standing on one side of the debate or the other) – regarding the amount of time spent attending to what the attention merchants have on offer. 

In his book entitled ‘The Sirens Call’, Chris Hayes (of MSNBC fame) writes how ‘Attention has never been more in demand, more contested, and more important than it is now. Unlike, say, oil, a chemical compound buried in the earth, attention cannot be separated from who we are and what it means to be alive. This rearrangement of social and economic conditions around the pursuit of attention is a transformation as profound as the dawn of the industry of industrial capitalism and the creation of wage labour as the central form of human toil’. 

OK enough said – let’s move on to topic #3.

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3) A recent rise in self-diagnosis

Despite the director of (America’s) National Institutes of Mental Health (NIMH), Tom Insel effectively rendering DSM–5 stillborn as a research language, and the revised criteria illegitimately expanded psychiatric diagnosis: Self-diagnosis is on the rise.

Regardless of the criticism from within science, medical research and psychiatry – we are presently witnessing full-scale personal/individual diagnosis migrating towards a domain where the boundaries between public and private have dissolved into the atmosphere of digital networks.

The result is DSM diagnosis has found an unlikely new home: social media – where it is no longer the property of therapists, physicians or scientists, but of algorithms and feeds.

Each new day inside the therapy room, in news articles read, and coffee shops visited, I hear the words of individualist diagnosis spoken. Taken for granted diagnostic words and people being described (and describing themselves) as narcissist, bi-polar, anorexic, OCD, mood disordered, oppositional defiant, etc.

On platforms like You Tube, TikTok etc., the pursuit of self-diagnosis appears ubiquitous and fashionable. Self-diagnosis unfolds in a rather short period of time, and repackaged as bite-sized content of relatable first-person tales.

However, at first glance, the self-diagnostic drift appears to serve a democratizing purpose. Social-media platforms provide unfiltered stories and experiences beyond what might be found in the DSM text itself.

Independent content creators bring to light the day-to-day realities of managing the language of problems – that are grounded in the Diagnostic and Statistical Manual of Mental Disorders. This could be at the heart of the appeal: the ability to see oneself in another’s stories, and to experience one’s own struggles in the experiences of others. In many ways, social media has done for mental health what decades of clinical practice have struggled to achieve. It has reduced stigma and created communities of compassion and care.

Social research studies suggest this kind of crowdsourced mental health information is widespread and influential.  Viewers are drawn to relatable, anecdotal content offered by influencers and creators. In a time when traditional health care systems often feel distant or inaccessible, social media provides some sense of proximity and inclusion.

Yet, for all its merits, behind the allure of accessibility and relatability lie the perils of misinformation, oversimplification, and (perhaps unknowingly) supporting of the neoliberal shift - away from understanding ourselves as persons who are indelibly shaped by, connected to, reliant upon, and responsible for one another. A move towards social media self-diagnosis further moves the individual towards an isolated self-reliant not quite measured up enough subdivision of the self – completely responsible for everything they feel, fail at, experience, and suffer through.

A few more quick announcements:

In and around 2011, when the 1st Edition of my book Narrative Therapy was published, I moved my yearly workshop/traveling schedule away from presenting workshops in America (except for few each year in California).  

I centred all the yearly teaching and supervision workshops across the span of 5 continents with regular visits to vibrant narrative therapy communities in Barcelona, Buenos Aries, Cape Town, Copenhagen, Dublin, Hong Kong, Mexico City, Oslo, Reykjavik, Sao Paolo etc., and of course Canada.

A return to the US changed about a year ago when the Director of Psychotherapy Networker - a charming fellow named Zachary Taylor - contacted me out of the blue. Our zoom chat was easy, one thing led to another, and I accepted his invite to present at the Psychotherapy Networker Couples conference last November 2024. 

The Couple conference was followed by another generous invite to the March 2025 Psychotherapy Networker conference – where I’m presenting 2 Foundations of Narrative Therapy workshops (one live/one online), and another 3 hour workshop on (NIRI) narrative therapy informed Relational Interviewing work with highly conflicted couples. 

A few people on this year’s Psychotherapy Networker conference presenter list includes my old pal Ken Hardy (who has twice keynoted our Therapeutic Conversations conference) and, another longtime friend Esther Perel (who has also twice keynoted our VSNT Therapeutic Conversations conference). I’m also looking forward to hearing Jon Kabat-Zin (who my physician/narrative therapist sister Anne has studied extensively with), as well as Dan Siegal. 

Hope to see you there.

The 3rd Edition of my book arrives in the next few months.

Loads of changes, loads of updates, and highlights of new brilliant theoretical practice ideas of several narrative practitioners.

It’s pretty good. Stay tuned.

Thanks for reading your way all the way to the bottom. Love to hear back from you. My private email is: spmadi33@gmail.com

Take care and many thanks again ~ Stephen x