Chapter 4 Flashcards
What are the risks in creating classification of mental health conditions?
Labels create a group that can then be stigmatized and discriminated against and the power to define “pathological” is by association to power to define “normal”
How does APA (medical model) define what a disorder is?
A significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress or disability or with significantly increased risk of suffering death, pain, disability, or a significant loss of freedom… must not be a respectable and culturally sanctioned response to a particular event… It must currently be considered a manifestation of behavioral, psychological, or biological dysfunction in the individual.
What are Corcoran and Walsh’s analyses of what a disorder is?
Underlying disturbances w/in the person = “disease model” of abnormality.
Deviant behavior or conflicts between person and environment are not disorders unless the cause of the issue falls within the individual.
Therefore, the person must change to be considered healthy.
What does a diagnosis consist of?
Signs and symptoms
(Symptoms reported by the client, signs observed by the clinician, and the real-world functional impact of both of these things)
T or f? The DSM diagnoses are descriptive based on symptoms.
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T or f? What we are really assessing is the whole person.
T
T or f? And even though we’re basing diagnoses on these checklists of symptoms and how many signs they may have or not have, we must take it into account how these other factors might impact symptom presentation. Things like their social network, their quality of life, the quality of their family relation, and work coping abilities and their experiences of things like violence and discrimination.
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So from the DSM 5 standpoint, what is the goal of classification of mental health conditions?
To provide clear descriptions of diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders. Now we’ve talked about a lot of these during the first module– the potential intrinsic value of a diagnosis what does it tell you about yourself to take your experiences and put a name to them? And how some have found that helpful in that it helps solidify this idea.
T or f? What do these experiences mean to me? And do others share them? Can also be in some ways damaging to have that label?
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How is communication a major benefit?
Allows us to communicate with other providers and with family members and to have some common language for how we describe the symptoms and experiences. The classification’s central to the study of etiology of mental health conditions in developing a treatment based on an understanding of where these conditions come from. And again, at the end of the session, we’ll revisit the concept of risk and how these labels have a negative flip side in which they expose people to also discrimination and stereotypes that they may otherwise not experience.
T or f? There is also a decision that is slowly being reversed to think about diagnoses categorically and not as dimensions of behavior.
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T or f? Accurate diagnosis considered necessary for selecting interventions.
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Who do we use the DSM-5?
Accurate diagnosis considered necessary for selecting interventions.
Competency in diagnosis allows social workers to claim “expertise” as a health profession.
Practitioners can use a common language across disciplines.
Similarly, training on the DSM is shared across professional education programs.
State social work licensing exams require knowledge of the DSM.
Why do we sometimes not want to use the DSM-5?
Person is not a diagnosis–reductionist thinking
Promotes a medical model
Views clients in isolation from environment and each other
No provisions for client strengths
Despite evidence that social support, coping style, etc. impact prognosis
Labeling
Modified labeling theory
Poor validity of diagnoses: high use of “NOS” and high comorbidity
Partly addressed in DSM-5
Financial incentives for APA and pharmaceutical industry make its objectivity questionable
Who said that madness and sanity are of equal value?
Socrates
Moving forward substantially to the 20th century. Adolph Meyer had a psychiatrist who had a view very similar to many social workers. What was that view?
diagnosis may be important but is secondary to presenting problems in understanding an individual’s experiences within what is now known as a biopsychosocial framework.
What issue did the anti-psychiatry movement raise?
Diagnosis is a problem
Some of the views from the critical schools of thought include what?
Medical naturalism, which suggests that mental illness is real objective and biological and diagnoses are used to label them– very much the psychiatric viewpoint, radical constructivism, which is the idea that mental illness is entirely a social invention, which corresponds to the anti-psychiatry movement. And social work probably falls somewhere close to what we know as critical realism, that there is some objective component to mental illness. There are actual symptoms that people experience, but the way we define and diagnose them is based on the social context, which may or may not be currently done with validity.
What type of science states that mental illness is real, objective, and biological, and diagnoses are used to label them?
Medical naturalism
What type of science states mental illness is a social intervention?
Radical constructivism
What type of science states there is an objective component to mental illness that is defined/diagnosed based on social context, not necessarily with validity?
Critical realism
T or f? The person-in-environment (PIE) approach is really based on the preference of many social workers and social work as a field, not to classify individuals as abnormal or disordered. Instead, they consider the fit between that person and the environment as an ongoing transactional process that either facilitates or blocks one’s ability to experience a satisfactory quality of life and social function. And so there are types of person-in-environment situations, like the reduced problems in social functioning, things like stressful life transitions or relationship problems that could perhaps be addressed as part of the interaction between the social worker and the client.
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What is the perspective?
Really a practice guiding principle that highlights the importance of understanding an individual and individual behavior within the environmental context, and even though we often rely on the DSM in the International Classification of Disease type systems to develop, conceptualize our diagnoses, and then discuss individuals across the coworkers, across the field among different professions. This person-in-environment perspective gives us a framework within which to understand assessment and diagnosis.
What is the PIE?
A holistic, four-factor classification system used to describe and code social functioning difficulties with common underlying terminology. And these four factors are social roles in relationship to others, social environment, and then mental and physical health. And we’re going to focus on the first two, and particularly the first one, social roles in relationship to others.
What are the advantages of PIE?
For one, it provides an opportunity to learn social work’s way of conducting a social functioning assessment from a more holistic perspective that considers mental health conditions as part, but not the whole, of our assessment, and provides a clear sense of what a practical next step should be in providing social work assistance. So we talked about some of the social causes of mental health issues before, and how understanding those gives you a target for your interventions and a target for how you want to work with the client to address the underlying causes of their difficulties. The person-in-environment perspective really emphasizes that and helps to identify what these social causes are.
The development of this perspective really came out of the growing need for a standardized social or classification system that was especially supported by Dr. Janet Williams, who is a social work representative on the DSM development committees. And she essentially tasked her colleagues with the challenge to come up with a social work rough equivalent, or one that’s more appropriate to the social work profession. A small group of researchers and clinicians in California primarily headed up this effort and developed this system where we break down our assessment into looking at social roles, social environment, and then mental and physical health.
So I mostly want to talk about Factor I, which is really one of the main unique contributions to this perspective. Factor I addresses the social roles one fulfills or is described by, and recognized and often regulated positions in society. And there are different types of interactive relationships that are covered here, including familial, occupational, interpersonal, and special life situations, or things that come up outside of these contexts.
And what this system allows is a formal coding approach to recording and, in a sense, diagnosing or indicating the presence of these different social contexts or situations. So it’s done with a seven-number system in which the first two numbers identify the role of a group in a specific role, such as family or parent role. The second two numbers identify the relationship type, such as uncertain or ambivalent or secure. The remaining three numbers provide a code to indicate the severity, duration, and coping, the extent to which someone is able to cope with or handle this potential environmental strength or stressor.
Here’s some examples to give you an idea of what this looks like. So we have these codes that indicate, for example, interactions with family, or parents, child, adults, interpersonal relationships, friends, family members, occupational things like– roles like inpatient, outpatient roles, and then even more specific things like if you’re in a prison setting or a parole setting. And then the second two digits indicate what the experience of that role is. So is there a sense of co-dependence between someone and their parents? Is there loss around someone and their close friend, like did they lose a close friend? And you could assess and record both who the relationship is with, with the first two numbers, and then with the second two, what that experience is subjectively like for the client you’re working with.
What is the structure of PIE?
There are four factors. PIE is a holistic, four-factor classification system used by social workers to describe and code social functioning problems with common descriptors. The four factors address problems and strengths under the following headings: Social roles in relationship to others Social environment Mental health Physical health
What are PIE’s two exciting features?
Provides an opportunity to learn social work’s way of conducting a social functioning assessment from a holistic perspective, and it provides the user with a clear sense of what the practical next step should be in providing social work assistance.
What is factor II in PIE?
Environment
What do factors III and IV draw in on?
Are largely relegated to the diagnosis drawn from the mental health and health coding systems.
How is the DSM organized and how may you use it to reference symptoms that a client may have and to then– based on that, identify the appropriate diagnosis as well as a couple other bits of information that you could record within this diagnostic system?
So the DSM-5 current version was published May 18, 2013 and was a revision of the DSM-IV that tried to reflect some changes in the field as well as increasing knowledge and understanding of mental health conditions, as well as trying to emphasize some of the more continuous, underlying nature of mental health conditions. The current undertaking was a massive project that took about 12 years and involved quite extensive reconsideration of the mental health diagnostic system.
What is the cornerstone of the DSM-5?
Reliability and that has allowed a common language to be shared among mental health clinicians in that we could reliably use one diagnosis and have a sense of what that terminology meant and to know what each other means when one of us says agoraphobia, or one of us says panic disorder, or one of us says borderline personality disorder and to have that common language.
T or f?
Despite this, there’s a general scientific consensus that in some ways, these are not fully validated diagnoses. So they’re reliably applied. They’re used in the same way. But they’re not necessarily directly corresponding to actually discrete or unique in the health or illness into these.
So really, what it means is that we have a useful system that is logistically valuable in mental health treatment, but is still based on kind of an evolving and not yet finished underlying science. The structure of the DSM– it’s broken up. The diagnoses are broken up into 21 categories, each with its own chapter.
And they’re really based around broader categories that share some underlying components. Neuro-developmental disorders are primarily childhood onset conditions that have some sort of biological foundation
T or f? Schizophrenia spectrum disorders include schizophrenia as well as other disorders that include psychotic symptoms like hallucinations and delusions, but are not primarily mood symptoms, which is then covered in bipolar and related disorders, and depressive disorders, and so forth down the list.
And while we won’t get to all of these categories during this course, we will cover quite a few of them in more depth. These disorders are grouped by common themes. And each disorder has a specific code, similar to the coding system we talked about with the person and environment framework.
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What is the structure of the DSM-5?
The structure of the DSM– it’s broken up. The diagnoses are broken up into 21 categories, each with its own chapter.
