Introduction to Critical Psychodiagnostics

Question 1

What is the relationship between mental disorder and clinical psychoology?

Answer 1

• The concept of mental disorder is fundamental to the discipline of clinical psychology.

Question 2

Is clinical psychology confined to only treating “disordered” conditions?

Answer 2

No.

Question 3

What classification systems are used in clinical practice and research?

Answer 3

• The Diagnostic and Statistical Manual of Mental Disorders (DSM).
• The International Classification of Diseases (ICD)

Question 4

What is the role of the DSM and ICD?

Answer 4

They are classification systems that are the primary judges of what is disordered, while remaining theory-neutral about etiology.

Question 5

What are the features of the DSM-V?

Answer 5

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)

Question 6

What are the features of the ICD 11?

Answer 6

• 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.

Question 7

What issues are involved in defining mental disorder?

Answer 7

• 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.

Question 8

What are the DSM-V criteria for mental disorder?

Answer 8

• 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.

Question 9

What are not mental disorders according to the DSM-V?

Answer 9

• 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.

Question 10

What is the ICD-11 definition of mental disorder?

Answer 10

• 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.

Question 11

Do the DSM-V and ICD-11 definitions of mental disorder adequately distinguish normal human feelings/thoughts/behaviours from disordered ones?

Answer 11

Question to consider.

Question 12

What are 5 different positions on mental disorder?

Answer 12

1. 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
2. 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
3. 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”)
4. While distress/suffering is real, the concept of ‘mental disorder’ was invented as a means of social control and should be rejected outright
5. 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.