Intro into critical psychodiagnostics

Question 1

Reason for mass psychosis in the USA

Answer 1

• 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

Question 2

three ways of identifying abnormality

Answer 2

1. psychiatry (western biomedicine)
2. psychoanalysis
3. statistics

Question 3

psychiatry tradition of identifying abnormality

Answer 3

• collection of signs and symptoms
• underlying physical disease
• separation of mind and body

Question 4

psychoanalysis tradition of identifying abnormality

Answer 4

• psychological signs and symptoms

- underlying psychopathology

Question 5

statistics tradition of identifying abnormality

Answer 5

• deviation from the norm

- impairment of functioning

Question 6

What is a DSM diagnosis?

Answer 6

• a syndrome (collection of signs and symptoms)
• statistical abnormality
• impairment of functioning
• exclusion of (supernatural aetiology/moral judgement)

Question 7

what do diagnoses play an important role in?

Answer 7

• treatment planning
• medical insurance
• communication between clinicians
• communication between researchers
• communication between clinicians and researchers
• civil and criminal legal proceedings

Question 8

What are the problems with diagnoses?

Answer 8

• 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)

Question 9

Philosophical commitments of the DSM

Answer 9

• atheoretical
• universalist
• acultural
• empiricist
• ‘disease’ over ‘illness’
• the syndrome is not the person
• consensus is key

Question 10

DSM vs African diagnostics

Answer 10

DSM:

• reliability
• taxonomy
• diagnosis precedes treatment

African Diagnostics:

• unconcerned with universalism
• causation-driven
• treatment informs diagnosis

Question 11

What are the myths about illness in the developing world

Answer 11

• 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

Question 12

effects of the myths about illness in the developing world

Answer 12

• 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

Question 13

examples of racially skewed diagnostics in Neighbors et al. (2003)

Answer 13

• 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

Question 14

Poverty and psychopathology

Answer 14

• poverty associated with risk for common mental disorders (neurotic, stress-related, somatoform and mood disorders)
• hopelessness, shame, stigma, humiliation, gender, illiteracy

Question 15

problem with DSM classifying the signs and symptoms of an individual patient

Answer 15

• does not say anything about social processes

- racism, economic exploitation, sexism, terrorism, cultural imperialism

Question 16

4 key issues in critical psychodiagnostics

Answer 16

1. culture
2. race
3. class
4. gender

Question 17

mental illness and the ‘ecological niche’

Answer 17

• mental illnesses change according to time and place
• sometimes they disappear altogether
• they depend on their enviro: ecological niches

Question 18

Transient mental illnesses

Answer 18

• Ian Hacking

- a concept that seeks to separate illnesses that change from those that do not

Question 19

effects of psychodiagnostics becoming public knowledge

Answer 19

• 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

Question 20

‘no fault’ psychotherapy

Answer 20

• 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.

Question 21

Are diagnoses necessary?

Answer 21

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

Question 22

descriptive psychiatry

Answer 22

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

Question 23

neuroscience in mental illness

Answer 23

-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

Question 24

4 perspectives on MD

Answer 24

1. realism
2. nominalism
3. social constructivism
4. pragmitism

Question 25

Realism perspective on MD

Answer 25

• MDs are ‘real’ things out there in the ‘real’
  world
  …until 10 years ago when it was still believed that neuroscience would reveal all

Question 26

Nominalism perspective on MD

Answer 26

• 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

Question 27

Social constructionism perspective on MD

Answer 27

• MDs are subject to misuse and abuse

- eg. silencing political dissidence (China, Soviet Union)

Question 28

Pragmitism perspective on MD

Answer 28

• defining MD “should be influenced by the useful purposes it is meant to serve”
• will diagnostic changes hurt or help patients?

Question 29

Lessons from DSM-IV

Answer 29

• 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)

Question 30

Problems with DSM V

Answer 30

• diagnostic inflation (binge-eating)
• secrecy (work members were forced to sign confidentiality agreements)
• inadequate field trials
• poor empirical documentation