Can the DSM ensure the objectivity of mental health research?

All of these points indicate the necessity of a sound etiological background for objectivist research in music therapy as well as for mental health in general. However, providing results of efficiency for methods without explicating the necessary theoretical framework seems to be the case for the vast majority of the music therapy research within this paradigm (Amir, LaGlasse &

Crowe, 2015; Burns, 2012). This is also the case for the totality of the body of research whose construct validity is trusted with the classifications of the “Diagnostic and Statistical Manual of Mental Disorders” (DSM). It is known that the DSM avoids declaring any kind of conceptual basis or theoretical framework to its diagnostic categories (although defining disorders as

“psychobiological dysfunctions” (APA, 2013) clearly reveals a theoretical stance, which, as mentioned, thus far suffers from the lack of evidence for reliable biological markers for different disorders). Therefore, if it can be argued that operationalizations of empirical research are constructs whose validity should be explicitly justified, then it can be said that such trend of

“objectivist” research takes responsibility for only one half of the aimed sense of objectivity, namely the utilization of the positivist experimental methodology and the statistical analysis, and resigns the other half to another authority, namely the DSM.

Unfortunately, descriptive (symptom-based) classifications of mental health in the International Classification of Diseases (ICD) and the Diagnostic and Statistical Manual (DSM), although in

their origination were not designed to replace altogether etiological (i.e. theoretical) explanations, have become victims of their own success (Fulford & Sartorius, 2009); Due to the extreme convenience they provide to professionals, they have overstepped their purpose and accelerated into becoming the golden standard of mental health research, as a presumedly superior alternative to an etiological foundation for ensuring the validity of mental health research. This however, as Fulford and Sartorius reveal, is not a position which professionals and scholars, after necessary and elaborate discussions, had decided that they are suitable to take.

Because of various reasons, such as ones mentioned thus far, they are by no means eligible to solely serve as the golden standard for objectivity in psychopathology research, within or outside the field of music therapy.

This is not only due to their firm basis in pseudo-explanation of disorders, as detailed above, but also because “the remaining half” of objectivity, namely positivist research methodology, as pointed out by Yardımlı (2013), does not strive to produce truly objective relations. Instead the aimed structure of results is local and probabilistic, and therefore the implications of research, in most cases, depend on researchers' subjective interpretations as to what rejecting a certain null hypothesis indicates. Furthermore, because the content of social sciences are unable to comply to the positivist methodology as seamlessly as laboratory experiments of natural sciences, whether or not “the objective efficacy” of a therapy technique itself can be derived from the experimental investigation of a local account of a multifaceted social interaction, depends on researchers and institutions' subjective thresholds regarding how well the variables outside the independent variable should be controlled.

Cohen (2009), recognizing objectivist music therapy research’s correlational outcomes’ inability to produce compelling results, states that if the underlying factors continue to remain a mystery, any evidence of impacts will fail to contribute to the field gaining the status which advocates desire it to have;

“Without established and proven theory to explain the positive effects of music and art on health ..., even observed changes would be questioned, trivialized, or viewed as not being real. To see even robust results as being real, science and society would need to understand the underlying dynamics or mechanisms that explained the findings” (p. 48-49, underline is mine)

It is known that objectivist research within music therapy, along with the rest of the positivist paradigm, does not consider objective proof as a valid notion, and instead produces reports of statistics for correlations and/or sequencings of phenomena (i.e. appearances), meaning the statistical likeliness of one appearance preceding another. Yet, as Cohen argues, in order to be truly satisfied with the outcomes, both the scientific community and the society need to be introduced to the reasons as to why and how such correlations occur, i.e. their underlying principles. Because only then such demonstrations of probability can be viewed not as local occurrences of chance, but as natural consequences of proven i.e. necessary properties of music and music therapy. Consequently, the likeliness of occurrence of results that are similar to a given local probabilistic outcome could be expected with confidence in environments other than the particular setting from which such probabilistic outcome originates. In other words, we can know, for example, that the result of a research regarding a statistically significant relationship between a music therapy intervention and treatment of a disorder is not necessarily specific to the research setting.

The need for proven relational qualities is especially crucial when the subject is therapeutic application of music, firstly because of the ubiquitous sensory presence of musical influence. It is common knowledge from daily life that the effects of the “object of music”, on the human psyche, besides healing, can be disturbing as well as neutral. Furthermore, it is demonstrated that it can even be adverse enough to be used consistently in various ways within settings of torture and warfare (Pieslak 2009, as cited in Andsell, 2015). In the original domain of this methodology, which objectivist research adopts in order to demonstrate the effect of music therapy interventions, if a certain dosage of a medical drug is experimentally demonstrated to both predict effectively adverse as well as curative effects, it would be more than unlikely to see it on the pharmaceutical counters. For this reason, as long as its effectiveness is presented in the same manner a medical treatment is presented, the principles of therapeutic application of music in music therapy needs to be made distinct, otherwise positive outcomes in themselves cannot be convincing for the public or other scientific disciplines.