Friday, May 10, 2013

Is Psycho-therapeutic diagnosis accurate?

I'm glad to read that some of the best neuro-scientists are challenging the validity of the Diagnostics and Statistical Manual used to diagnose patients.  Specifically, the National Institute of Mental Health (NIMH) is distancing itself from the the American Psychiatric Association and its upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The director of NIMH, Tom Insel, writes:
The goal of this new manual, as with all previous editions, is to provide a common language for describing psychopathology. While DSM has been described as a “Bible” for the field, it is, at best, a dictionary, creating a set of labels and defining each. The strength of each of the editions of DSM has been “reliability” – each edition has ensured that clinicians use the same terms in the same ways. The weakness is its lack of validity. (Link to source.

After finishing my Master's Degree in counseling a few years ago, I intentionally elected to not pursue licensure by the State.  This was an elective decision, rooted in many reasons, one of which had to do with my antipathy with psychological diagnosis for billing.

I am a person who embraces the ideas of existential philosophy and human-personhood including Theistic elements.  Additionally, I embrace the manifold complexities of what science can "know" about the body and the brain.  [I accept Science!  I just think it continues to find that the more we know - the more we realize what we do not know.]

The simple, neat and tidy" diagnostic descriptions from the DSM (Diagnostic and Statistics Manual) bothered me for what they failed to contain - and for how they qualified and quantified certain subjective factors.  I had no trouble passing the class on Psychopathology when I applied the ideas within narrow categories to sample-case-studies, but I could not make myself believe the categories were more than helpful frames of reference in most cases, and even in the best diagnostic situations, they still had to be discerned alongside many other cognitive, hormonal, cultural, social and situational dynamics.

In my final cumulative research project, after having spent many hours with a client, I completed a full diagnostic evaluation of him.  I earned a "C" on the project, thus, pulling my grade to a B, and "ruining" the 4.0 GPA I had worked for was lost in my Master's Degree.  Given the rhetorical directness with which I challenged the Professor of the class, and the Director of the program, in his review of my diagnosis, I'm surprised I did not receive a lower grade in the course!

Though I was a straight "A", competent student, also an adult who had spent countless hours with persons in personal and pastoral settings, I did not diagnose my client in the way the professor expected from me based on his giving greater validity to the DSM-IV.  Even though I had spent many hours with the client (and the Professor only knew him as a fictitious name on the pages of my full report), and even though I described the nature of why I ruled-out the diagnosis that the professor expected of me, and even though I defended my diagnosis at my Oral Defense, based on the entire social-situational perspective that I saw from the client, I was forced by the professor to resubmit the paper and use his diagnosis in order to pass the class and finish the program.

Oh, the irony therefore, that the links I include in this post actually came to my awareness from the self-same professor who, now in a new role himself professionally at a hospital it seems is around other scientifically astute persons and he is recognizing the hubris of the DSM as a perfect model for pristine diagnostic evaluation.  

I do not believe the categories of the DSM are "wrong," nor unhelpful. (In my view, Thomas Szasz went too far.)   I believe, instead that the hubris with which some clinicians use the categories to narrowly and exclusively "box" persons in to limited confines, only discernible to those with the skill to diagnose in these predictable and exclusionary ways, can too often be an act of vanity.

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