The constructors of the DSM point to the following positive uses for its system of psychiatric diagnostic codes: It can be helpful for clinicians and mental health practitioners as they construct treatment plans, especially evidence-based treatment plans. It provides a consistent structure and vocabulary for professionals, which helps with communication and collaboration.
It can facilitate continuity of medical care and collaboration between professionals of varying treatment modalities. It is consistent with many forms of current medical record keeping. It can facilitate unified data collection for survey, pharmacological and other research purposes. It can be instrumental for the compilation and retrieval of statistical health information.
It simplifies the reporting of unified data to interested third parties, such as the World Health Organization and insurance companies.
DSM-based research has repeatedly shown very poor reliability and, therefore, questionable validity. Critics of DSM-5 would agree that this statement remains true, as there is general agreement among them that diagnostic loosening and expansion of diagnostic criteria has resulted in an even greater decline in reliability and validity while at the same time medicalizing many normal behaviors. Unfortunately, psychiatric labeling has been developed and applied in biased ways and will most likely continue to result in more harm than good.
Labeling normal behaviors as mental disorders financially and professionally serve psychotherapists of all theoretic orientations. Following are some examples of how the DSM turns normal behaviors and temperaments into mental illness. Most undergraduate, graduate and postgraduate education neglects critical aspects of training in regard to the complex process of diagnosis.
The current limitations in most training programs make it difficult, if not impossible, for the student or clinician to approach the DSM from a balanced perspective or to employ critical thinking in assessing the impact and utility of the tool.
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In Summary: Diagnostic tools can be very helpful in assisting people in healing and becoming healthier. The DSM is more of a political document then a scientifically based text. The very frame of the DSM is distorted by a primarily intra-psychic-individual focus paired with the relative exclusion of environmental, societal, political and familial concerns. Most clinicians are inadequately trained in its use, and used without the benefit of critical thinking, it can harm more than help. More specifically, the DSM discriminates against women, minorities, the lower class, the elderly, gays and lesbians or anyone who deviates from the values of the, perhaps well-meaning but biased, dominantly upper class white male political contingency that created it.
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The DSM is constructed predominantly by biological psychiatrists with strong influences from pharmaceutical and managed care companies. The construction of mental illness is a western cultural artifact, which can be viewed, in contrast, to the more organic and inclusive systems existing in many indigenous cultures. Following is an example of a culture in which members who characteristically exhibit different and unique not within the bell curve behavior are treated in a respectful, holistic manner by the community system.
While my stated mission was to help several remote villages develop fishponds, I was more fascinated with the sense and structure of the villages. My mission to promote fish soon took second place to my interest in the psychological, sociological and spiritual dynamics of the village. I was swept up by the strong current that flowed through and around this collection of families, joining them in a circle of interdependence, acceptance and mutual support.
This current embraced the strong and the weak, the good and the not so good, the healthy and the frail and the so-called normal and the different.
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Each was a treasured and colorful piece of the mosaic that made up this vital community. And to be sure, there were those who also occupied common basic roles, equivalent to our butcher, baker and candlestick maker. There were villagers who needed to be carried everywhere. There were villagers who needed to be constantly protected from harming themselves. Yet, the traditional village not only tolerated such diversity, they also, in fact, truly embraced and often celebrated the differences, offering a wide network of support for all. The village respected the roles and functions of the village shaman, the fool, the warrior and others who varied from the norm, providing them with food and shelter.
Whether strong or frail, healthy or handicapped, each community member was supported physically, emotionally and spiritually. When necessary, special healing rituals focused on the mentally or physically frail. It is likely that most clinicians entering a village, such as the one described above, with the DSM and a prescription pad under their arm might prescribe anti-depressants and cognitive therapy to the Grouch, calm the Clown down with a little mood stabilizing medication, and relieve the Witchdoctor of his ritualistic behavior with a cocktail of treatments for OCD. The Man-who-Talked-to Trees and the Medium could clearly benefit from an anti-psychotic medication and probably psychiatric hospital incarceration, while the young Warriors, depending on their age, would probably label them with Disruptive Mood Dysregulation Disorder.
Some would say they might benefit from these interventions, and then again perhaps a combination of approaches would be the ideal.
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This is central to the definition of therapy and it is what we are most likely to lose if we allow it to be legislated away in favor of cost cutting procedures and an over emphasis on biological intervention. One must maintain caution, however, so that the distilled, conceptual jargon developed, in part, as a response to political, economic and social pressures does not confuse the larger contextual elements of truly helpful diagnosis. Used without benefit of critical, contextual thinking, the DSM can be unwittingly used as a weapon, perpetrating the violence of intolerance upon individuals and groups expressing diversity of many kinds.
Diagnosis involves judgment.
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Online Resources by Zur Institute, Inc. Search for:. Audios Articles Mixed Format. CE Courses by Subject. Required Courses. View by CE Credit Hours. Author Name. Introduction Because most undergraduate, graduate and postgraduate courses relatively uncritically present the DSM as an objective scientific document, this summary focuses exclusively on the critical view. Overview of Critique of the DSM-5 Historically, many clinicians have been unaware that the DSM is more political than scientific, that there is little agreement among professionals regarding the meaning of vaguely defined terms, and that it includes only scant empirical data.
Disruptive Mood Dysregulation Disorder: Some proponents of this new DSM-5 childhood disorder hope that the new diagnostic criteria will help clinicians in their differentiation processes and, therefore, keep them from inappropriately and prematurely diagnosing childhood Bipolar disorder. Critics wonder, however, why it is necessary to create a new disorder in an attempt to correct the over-diagnosing of another disorder.
Cultural Sociology of Mental Illness: An A-to-Z Guide
Critics also voice fear that the criteria of this new disorder are likely to be used clinically to include the normal emotional disregulations of childhood. Imagine all the possible consequences of a child starting out life with this label being applied to his or her identity. One wonders. Will temper tantrums now be diagnosed as a mental disorder? Will our young ones be unnecessarily burdened with a diagnosis of mental illness and be medicated with powerful psychotropic medications?
Will new medications be developed to treat the new disorder? Will pharmaceutical companies conduct educational advertising campaigns targeting the attention of concerned parents via the television and glossy adds in parenting magazines? It is stunning to consider the long-term implications resulting from these decisions. The DSM, and pharmaceutical companies, have historically tended to ignite and fuel diagnostic trends, some of which have turned into wild fires.
During the past two decades, child psychiatry has already fired up three fads — a tripling of Attention Deficit Disorder, a more than twenty-times increase in Autistic Disorder, and a forty-times increase in childhood Bipolar Disorder. Only time will tell how this new diagnosis will help or damage our vulnerable children.
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Grief: DSM-IV had an arbitrary two-month cutoff period that excluded a diagnosis of depression for a grieving person. The two month criteria which did not have clinical or research credibility has been removed in the DSM-5, therefore making it even easier to diagnose a grieving person with depression. Some normal, necessary human reactions can now be medicalized and medicated. Minor Neurocognitive Disorder: The new DSM-5 diagnosis, Minor Neurocognitive Disorder, burdens a large false positive population of normal people experiencing natural minor decline in cognitive function with a label of mental illness.
As this group is not necessarily at special risk for developing dementia, an unnecessary diagnosis can engender fear, humiliation and anxiety about the future. These include re-experiencing, arousal, avoidance and persistent negative alterations in cognitions and mood.
Diagnostic thresholds have been lowered for children and adolescents and separate criteria have been added for children 6 and under. Some were originally concerned that the new criteria would relax the criteria to include normal reactions to stress, but this does not seem to be the case. Binge Eating Disorder: Excessive eating, 12 times in 3 months, has become the criteria for inclusion to a psychiatric illness called Binge Eating Disorder.
This might include most people during the holidays, if one starts with Halloween candy and ends with New Years leftovers. Many of us could be mentally ill for a quarter each year. This reduction can be seen as beneficial in the sense that the diagnosis of Autism will be more accurate and specific but, those concerned with the well being of children affected, fear a disruption or discontinuation of services for some.
The problem here has less to do with the change in diagnostic criteria and more that school services should be tied to educational need and less to psychiatric diagnosis. Substance Abuse: New criteria calls for first time substance abusers to be lumped in with hard-core addicts.
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Addiction: Imagine how introducing the concept of Behavioral Addictions e. Imagine the marketing potential for treatment programs and new medications. Where will normal go? Anxiety disorders: The biggest change in these disorders is that the person no longer needs to perceive their anxiety to be excessive or unreasonable. That may open up diagnosis and medicating to very general everyday worries that last more than 6 month. This covers a lot. We have all seen that the DSM-IV sometimes obscured the line between a psychiatric diagnosis and the worries of everyday living. There are no parallel diagnoses of PMDD for men e.
Based on that, the U. Supreme Court ruled in Atkins v. Virginia that it is illegal to execute a mentally handicapped person. The DSM-5 dropped the IQ criteria in favor of a more subjective clinical analysis of behavior-related developmental indices. Such shifts can have enormous social and legal implications that are of life and death in nature.
This is just one of the earliest implications to arise forensically. Many others will follow. DSM-5 contains a page titled, Cautionary Statement for Forensic Use of DSM-5, which states, among other things, that the DSM-5 was developed to meet clinical needs rather than the technical needs of the court or to provide treatment guidelines.