Introduction to Critical Psychodiagnostics Flashcards
1. Know what the main diagnostic classification systems for mental disorders are and who produces them 2. Know how these systems define mental disorder and what the difficulties with these definitions are 3. Understand the concept of diagnostic inflation and the factors that drive this process 4. Understand the remedies that can reduce diagnostic inflation
What is the relationship between mental disorder and clinical psychoology?
- The concept of mental disorder is fundamental to the discipline of clinical psychology.
Is clinical psychology confined to only treating “disordered” conditions?
No.
What classification systems are used in clinical practice and research?
- The Diagnostic and Statistical Manual of Mental Disorders (DSM).
- The International Classification of Diseases (ICD)
What is the role of the DSM and ICD?
They are classification systems that are the primary judges of what is disordered, while remaining theory-neutral about etiology.
What are the features of the DSM-V?
Who: American Psychiatric Association (APA).
Where: It is the official USA classification system, though it is used elsewhere.
What: Only includes mental disorders.
Cost: ±R4500
Description: Clear operational criteria, time frames, exact number of symptoms (aims at inter-rater reliability)
What are the features of the ICD 11?
- Who: World Health organisations (±193 member countries)
- Where: Official WHO global classification system, including in low-income countries.
- What: Includes medical diseases and mental disorders.
- Cost: Available freely on the internet.
- Description: Description and guidance rather than operational criteria- more room for clinician judgement in making diagnoses.
What issues are involved in defining mental disorder?
- Question: What do we mean when we say that a psychological condition is not merely a form of normal human distress but a form of “mental disorder”?
- There are no biological markers for most mental disorders, only patients’ subjective reports and clinicians’ observations.
- There is no consensus on how to operationally define mental disorder, mainly because there is also no definition of “mental order” to set it against.
- Etiological uncertainty and theoretical fragmentation add to the definitional difficulties.
What are the DSM-V criteria for mental disorder?
- A syndrome characterised by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour.
- Reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.
- Usually associated with significant distress or disability in social, occupational or other important activities.
What are not mental disorders according to the DSM-V?
- An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not mental disorder.
- Socially deviant behaviour (political, religious, sexual) and conflicts that are primarily between the individual and society and not mental disorders unless the deviance or conflicts result from a dysfunction in the individual.
What is the ICD-11 definition of mental disorder?
- Syndrome characterised by clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour.
- Reflects a dysfunction in the psychological, biological, or developmental processes that underlie mental and behavioural functioning.
- Usually associated with distress or impairment in personal, family, social, educational, occupational, or other important areas of functioning.
- The are no criteria that consider cultural or social factors.
Do the DSM-V and ICD-11 definitions of mental disorder adequately distinguish normal human feelings/thoughts/behaviours from disordered ones?
Question to consider.
What are 5 different positions on mental disorder?
- Mental disorders are real neurobiological entities and can (or eventually will) be measured/detected accurately through scientific methods (eg current NIH position); DSM disorders just describe what is actually out there
- Mental disorders are real, but complex; they can’t be neatly ‘carved up’ like the DSM tries to do (e.g. there are probably a several schizophrenic disorders, rather than just one “schizophrenia”); within this complexity, diagnostic systems provide a useful heuristic (mental short-cut for making clinical judgements) but that’s all
- Mental disorders are social constructs of particular times and contexts, they are ways of making sense of complex experiences; how we try to describe them (eg DSM diagnostic categories) influences how we see/experience them, and this will change over time and place (see Ethan Watters book “Crazy like us: The globalisation of the American psyche”)
- While distress/suffering is real, the concept of ‘mental disorder’ was invented as a means of social control and should be rejected outright
- Although there are some ‘real’ mental disorders, others have been invented in an ongoing process of medicalisation (pathologizing normal human responses) and this medicalisation process benefits some (eg Big Pharma; and neoliberalism, capitalism more broadly) and disempowers/marginalises others.
What is diagnostic inflation?
- This describes the general trend towards an increase in number of disorders, and number of people being diagnosed over time.
- The big jump in the DSM was in 1980.
What factors are involved in diagnostic inflation?
- Over time the DSM changes its diagnostic criteria and this can lower the threshold at which people can receive a diagnosis.
- Consider environmental factors.
- Diagnosing children: the pharmaceutical industry might be marketing drugs for children as this is an “untapped” sector.
- It is easier to give someone a pill than to fix structural issues.
How does Carl Marx’s theory of alienation in late-stage capitalism relate to diagnostic inflation?
When neoliberal ideology, which prioritizes market logic and individual responsibility, intersects with medicalization, it creates a situation where individuals are encouraged to understand their distress as individual biological problems, thereby obscuring the potential role of social and economic forces [3]. This focus on the individual aligns with Marx’s concept of alienation, where people become estranged from their labour, themselves, and each other under capitalist conditions.
- I think also people are more likely to suffer more when they are alone and feeling lonely. When people have strong social bonds they might be better able to handle their daily stressors.
