Intro into critical psychodiagnostics Flashcards
Reason for mass psychosis in the USA
- 18/20 psychiatrists who wrote the APA clinical guidelines for dep, bpd and schizo have ties to the drug industry.
- increase use of psychoactive drugs, increased claims for disability income due to mental disorder
- $12.6 bil in sales of antipsychotics in 2011 given to: unruly kids, dementing elderly people, depression, anxiety, insomnia
three ways of identifying abnormality
- psychiatry (western biomedicine)
- psychoanalysis
- statistics
psychiatry tradition of identifying abnormality
- collection of signs and symptoms
- underlying physical disease
- separation of mind and body
psychoanalysis tradition of identifying abnormality
- psychological signs and symptoms
- underlying psychopathology
statistics tradition of identifying abnormality
- deviation from the norm
- impairment of functioning
What is a DSM diagnosis?
- a syndrome (collection of signs and symptoms)
- statistical abnormality
- impairment of functioning
- exclusion of (supernatural aetiology/moral judgement)
what do diagnoses play an important role in?
- treatment planning
- medical insurance
- communication between clinicians
- communication between researchers
- communication between clinicians and researchers
- civil and criminal legal proceedings
What are the problems with diagnoses?
- they tend to medicalize social problems
- they can be mechanisms of social control (eg Drapetomania was a conjectural mental illness that, in 1851, American physician Samuel A. Cartwright hypothesized to cause Black slaves to flee captivity)
Philosophical commitments of the DSM
- atheoretical
- universalist
- acultural
- empiricist
- ‘disease’ over ‘illness’
- the syndrome is not the person
- consensus is key
DSM vs African diagnostics
DSM:
- reliability
- taxonomy
- diagnosis precedes treatment
African Diagnostics:
- unconcerned with universalism
- causation-driven
- treatment informs diagnosis
What are the myths about illness in the developing world
- mental illness does not exists
- if it does, it’s not viewed as problematic
- if it is, it remains unstigmatised
- it is cured exclusively by indigenous healers
effects of the myths about illness in the developing world
- beliefs feed into cultural stereotypes around a western monopoly on rationality and science
- Politically, romanticised views of the ‘developing’ world can unwittingly support racialized discourses of differenc
examples of racially skewed diagnostics in Neighbors et al. (2003)
- black psychiatric inpatients more likely to be diagnosed with schizophrenia than white inpatients
- white inpatients were more likely to be diagnosed with mood disorder than black inpatients
- result of preconceived notions clinicians may have about patients based on race, gender or socioeconomic status
Poverty and psychopathology
- poverty associated with risk for common mental disorders (neurotic, stress-related, somatoform and mood disorders)
- hopelessness, shame, stigma, humiliation, gender, illiteracy
problem with DSM classifying the signs and symptoms of an individual patient
- does not say anything about social processes
- racism, economic exploitation, sexism, terrorism, cultural imperialism
4 key issues in critical psychodiagnostics
- culture
- race
- class
- gender
mental illness and the ‘ecological niche’
- mental illnesses change according to time and place
- sometimes they disappear altogether
- they depend on their enviro: ecological niches
Transient mental illnesses
- Ian Hacking
- a concept that seeks to separate illnesses that change from those that do not
effects of psychodiagnostics becoming public knowledge
- individualistic reductionism (?)
- stigmatisation through naming
- mystification of relational/ social. political/ economical factors
- creation of help seeking population
- creation of help- providing population
- creation of ever-expanding professional vocab
‘no fault’ psychotherapy
- the process for diagnostic labelling is not essential for successful psychotherapy
- In fact, ‘successful’ diagnostic interviewing sets the tone for a problem-focused psychotherapy
This is because:
- Diagnostic interviewing is a problem-saturated way of talking
- Problems only emerge if the patient’s self-narrative is also problem-centred
- ‘no fault’ psychotherapy does not depend on fine-grained diagnostic decision-making
- Rather, its goal is to liberate patients from prescriptive, restrictive and ultimately unhelpful discourses about the self.
Are diagnoses necessary?
yes:
-medical aid considerations
-it helps to know what you’re dealing with
no:
-stops the conversation before it has begun
-diagnoses can become self-fulfilling prophecies
-point is to treat the patient not the diagnosis
descriptive psychiatry
based on the premise that systematic observation and classification will reveal causal patterns
BUT
Frances and Widiger (2012) believe it has been unsuccessful in promoting a breakthrough discovery of the causes of mental disorders
neuroscience in mental illness
-we know a lot about the normal brain
BUT
-Frances and Widiger (2012) say it has almost completely failed to make clear the causes of mental illness
4 perspectives on MD
- realism
- nominalism
- social constructivism
- pragmitism
Realism perspective on MD
- MDs are ‘real’ things out there in the ‘real’
world
…until 10 years ago when it was still believed that neuroscience would reveal all
Nominalism perspective on MD
- MDs are “useful heuristic constructs” (heuristics are simple, efficient rules, learned or hard-coded by evolutionary processes, that have been proposed to explain how people make decisions, come to judgments, and solve problems typically when facing complex problems or incomplete information.)
- eg. current thinking around schizophrenia
Social constructionism perspective on MD
- MDs are subject to misuse and abuse
- eg. silencing political dissidence (China, Soviet Union)
Pragmitism perspective on MD
- defining MD “should be influenced by the useful purposes it is meant to serve”
- will diagnostic changes hurt or help patients?
Lessons from DSM-IV
- need critical reviews of proposals for diagnoses
-experts must be reigned in:
–Diagnostic criteria work differently in a research setting than in a clinical setting.
–Experts aren’t aware of the various players in the game (courts, clinicians, Big Pharma)
–Be careful about who serves on task forces and in work groups
–Experts are concerned about false negatives, not positives.
Boundaries of MDs get bigger (e.g. ADHD)
-proposals must be tested in the field
-risk-benefit analyses are imperative
-be conservative (in the addition of new disorders)
-skillful writing in mandatory (in case of being misunderstood)
Problems with DSM V
- diagnostic inflation (binge-eating)
- secrecy (work members were forced to sign confidentiality agreements)
- inadequate field trials
- poor empirical documentation
