|Labeling: Many people find the use of psychiatric labels dehumanizing and stigmatizing.|
|Stigma: In certain circles, presumptions are made about people with diagnosed "mental disorders."|
|Presumptions: Many professionals become over-reliant on the DSM and presume that people with|
|unusual lifestyles, certain difficulties, or certain ways of coping, are mentally "disordered," which all too |
frequently translates into ideas of mental "illness." Rarely does anyone ask, "Who wrote this book
anyway, and what is the quality of science to back it up?"
|The Medicalization of Life Problems: Not everyone who has a problem or seeks help is "ill." Seeing|
|difficulties in living as an "illness" suggests that difficulties in living should be treated with medication |
rather than other modalities such as talk therapy. Medications and the pharmaceutical industry will be
discussed on another page.
|Over-generalizations: Even if someone's condition can be found in the DSM and named, not|
|everyone's conditions can be found in there. Again, the individual stands to get lost due to the statistical |
aspect of the DSM. Statistics may help us understand general trends, but they do not help us much with
unique and complex individuals. It is easy for the diagnostician to forget this and to use the DSM like a
|Cook-book Mental Health Services: It is not uncommon for those who provide mental health services|
|to diagnose every single person who walks through their door with some sort of mental disorder out of |
the DSM. Among other possible reasons for this is the fact that most insurance companies will not pay
for therapy unless it is "medically necessary," and again, we see the medicalization of life problems.
Therapists and other mental health professionals want their paychecks as do hospitals and mental health centers. Rarely do mental health professionals fail to diagnose something. Rarely does the client hear," I don't think I have a diagnosis for you."
|Better Services: Services could be better provided if the practitioner simply listened closely to the|
|complaints and concerns of the people who come to them for help, rather than risk bias based on DSM |
|Communication Among Professionals: Again, we look at presumptions. Mental health practitioners|
|are busy people. When there is communication among them, often the time saver is to report a |
diagnosis. Unfortunately, one depressed person is not like another, and much gets lost in translation.
|Categorization: Although it is not always useful, categorization can be very helpful when we are trying to understand the differences between one thing and another. To the extent that psychiatry uses scientific method to understand these distinctions, it is no different than the other sciences, such as physics, biology & chemistry.|
|Limits of Categorization: The DSM is clear that not all aberrant behavior is to be classified as a mental|
|disorder. In order to be diagnosed with a mental disorder, not only does an individual need to meet |
certain criteria, but the individual needs to show a clear disruption in their usual level of functioning,
and/or experience significant subjective distress about their feelings, thoughts or behaviors. If an
individual shows no disruption in their usual level of functioning and is not experiencing distress, in most
cases, no diagnosis is given. Too, the most recent DSM's have included dimensional factors which take
into consideration the duration of the disturbance, age of on-set, persistence and severity of the
symptoms and so on.
|Cultural Factors: The DSM is aware of cultural factors and does not diagnose people with mental|
|disorders simply because their ways are different from the dominant culture. Where there are |
differences between cultures or among sub-cultures, we enter the realm of sociology and may discuss
the relative merits of cultures in a sociological context. Nevertheless, people from other cultures can be
diagnosed, with the same precautions, if their symptoms are clearly out of line with the culture to which
they identify. The DSM includes a number of examples of aberrant behavior in various other cultures
which may or may not constitute mental disorders in those cultures.
|On-Going Study: The DSM is well aware that its various categories are not all-inclusive. Each new|
|edition of the DSM outlines a set of categories that warrant further study. Sometimes, these are |
disorders that are on their way to inclusion in the DSM and some of these disorders have been excluded
from the most recent editions but are still considered to have merit in using the DSM's categorical system.
|Striving to Get the Full Picture: The DSM recommends the use of a "multi-axial" format in diagnosis|
|toward understanding as fully and accurately, the full picture of the individual. Generally, there are five |
axes which include, in order;
|Knowledge of Its Own General Limitations: Although the DSM does not outline all of its own|
|limitations, it is quite straight-forward about its limitations in general. These limitations are acknowledged |
early in the text and for a perceptive clinician, these reminders are evident throughout the book.
|Cautions Issued to Clinicians: The DSM actively cautions clinicians to be aware of its limitations and to use the DSM responsibly. Clinicians are advised to make use of their own training, experience, and clinical judgement in making diagnoses and to not rely upon the DSM alone or to use it in a cook-book fashion. This is consistent with the ethical standards of most mental health professionals. Mental health professionals are encouraged to do their best to make sure their assessments and other professional work is not misunderstood or misinterpreted. For this and other reasons, non-professionals are discouraged from using the DSM.|
|Psychiatric Diagnosis & the Diagnostic and Statistical Manual
of Mental Disorders (DSM): What You Should Know and Why
|Christian Wolff, Psy.A., Licensed Psychologist Associate • Psychotherapist & Counselor
820 NW 21st Avenue, Suite B. Portland.Oregon. 97209. 503.381.2032. firstname.lastname@example.org
|Diagnosis of Mental Health Conditions: The Good, The Bad, and the Ugly
|DSM V - Spring 2013