Essay on "Diagnostic Approach in Mental Health"

Essay 10 pages (3549 words) Sources: 30

[EXCERPT] . . . .

Critical Evaluation of Diagnosis and DSM

The creation of the DSM's fifth edition (i.e., DSM-5) has revitalized and further propelled critical discussion with regard to diagnosis' role and status in the area of mental health. This edition of the manual has garnered significant censure. Of particular importance is the criticism faced with regard to this highly popular, widely applied, and virtually mandatory manual's role in medicalization processes (Pickersgill, 2013). Issued and managed by the American Psychiatric Association, this manual is promoted as a hi-tech accomplishment based on science and data. The DSM's design and arrangement imparts a picture of accurate, rigorous criteria, which may be applied for formulating a mental ailment's diagnosis. This degree of precision has convinced a number of medical professionals to reach the conclusion (without any critical analysis) that the manual establishes and defines distinct, clear-cut disorders in a way that proves valuable and convenient to professionals as well as consumers. It comes with a fair share of benefits. When utilized appropriately, it can prove greatly reliable. However, this only implies that healthcare professionals who make use of this manual frequently reach an identical diagnosis. Practitioners and researchers express concerns regarding the fact that their inferences, while consistent, are usually erroneous, and might end up causing more damage than cure (Conner, 2015).

Theory Applied to Practice

The DSM manual has invariably provided an explicit approach to patient diagnosis. In other words, the person either 'has' or 'is free from' a particular ailment. Every individual who undergoes the examination (evaluation) and diagnosis process can definitely be placed in one category -- either 'yes' or 'no' -- in relation to a specific type of psychopathology. Of late, and particularly with regard to certain syndromes (like, personality disorders), increasing empirical support and emphasis is being placed on non-categorical psychopathological approaches. In specific, the dimensional model has been out forward by several doctors and medical scholars (e.g., Costa & Widiger, 2001; Trull & Durrett, 2005; Widiger & Trull, 2007). As per this perspective, the problem isn't an ailment's absence or presence. Rather, it is with regard to which point on a dimension or continuum the symptoms of a patient fall. Consider the example of a client (say, Robert) who strongly tends to elude social settings as he fears rejection and disapproval from others. An uncompromising system would necessitate that his psychologist establish whether or not he suffers from a certain disorder -- probably avoidant personality disorder or social phobia. On the other hand, a system that is dimensional would not necessitate a 'no' or 'yes' reply. Rather than facing a dichotomous decision, the psychologist will be required to rank Robert's condition on a scale of nervous evasion of social circumstances. That is, instead of a straightforward 'present' or 'absent' decision, the psychologist will have to ascertain which point on the continuum ideally represents the symptoms displayed by Robert (Pomerantz, 2013).

Professional & Ethical Issues

The matter of diagnosis is delicate in the context of professional psychology. A large number of psychologists feel a degree of ambivalence concerning the professional necessity to diagnose the disorder of a client prior to commencing therapy (Welfel, 2010). Earlier, diagnoses were generally regarded as demeaning labels or irrelevant categories. However, in the year 1980, the American Psychiatric Association issued its 3rd edition of DSM (i.e., DSM-III), and as its nosology proved to have better clinical use than earlier editions of the manual, diagnosis grew into the keystone of medical practice (Maxmen, Ward, & Kilgus, 2009). At present, some practicing psychologists do have doubts about psycho-diagnosis' value, but there are very few who avoid making diagnoses. As client disorder diagnosis has now become a tradition in clinical settings, it is imperative that it occurs to the highest degree of accuracy possible. Clients with correctly-diagnosed issues will be able to receive superior quality treatment, and, in turn, have greater likelihood of improving. On the other hand, those with incorrectly-diagnosed issues may receive the wrong treatment, poor prognosis, and end up wasting both money and time. Doctors who incorrectly diagnose a patient's condition may also end up wasting a considerable amount of effort and time, and may be faced with legal and ethical sanctions. Psycho-diagnosis isn't precisely a clinical or scientific process. Rather, it represents a multifaceted task that requires comprehensive understanding of the system of diagnosis, superior information collection and interviewing skills, and sound clinical judgment. Because of this complexity, qualified doctors can have genuine differences in opinion with regard to illness diagnosis of any given patient (Thomason, 2014).

Numerous APA-prescribed (2002) ethical values and codes are relevant in the psycho-diagnosis context. According to principle C, psychologists uphold the values of scrupulousness and integrity and don't involve in dishonesty, ruses, or deliberate misrepresentation of information. According to standard 9.03, psychologists procure informed permission for providing diagnoses, including confidentiality limits and a clarification of third-party involvement. The above statements establish clearly that deliberate misdiagnosis is an unethical act. Psychologists may also tend to over-diagnose patient problems solely for patient benefit, as there would be no need for treatment, otherwise. However, as payment is made only if, and after, treatment is availed, they cannot avoid the manifestation of self-interest. As intentional under-diagnosis can actually ensure that client treatment isn't eligible for recompense, it may appear to be more humane and a less serious unethicality than overstated diagnosis. However, since it is a form of dishonesty, it contradicts APA's ethical principles. Furthermore, if under-diagnosis by a practitioner leads to incorrect treatment, they may face a lawsuit for clinical malpractice (Kirk & Kutchins, 1988).

Reflection & Learning

DSM-5 carries on with causing damage to psychology and watering down its value in the mental health field, to the extent that it has turned into a commodity, with psychiatrists themselves becoming irrelevant. Even death isn't so clear as to allow one to conclusively operationalize its meaning. This holds truer in the mental disorder field, which is cloudy and ambiguous at best. In other words, DSM's mental disorder nosology is guided by the necessity to acquire a set of definite, internally consistent clinical representations as the external indication of certain invisible biochemical damages. By resolving the issue of whether to categorize mental disorder as biological or psychological, we will, by the very act, resolve the matter of whether mental disorder's ultimate nosology has a dimensional or categorical form. Despite the Committee not openly espousing the biological reductionist mental disorder theory, they have redirected their focus of reasoning by inference. If it appears that the right mental disorder model is of a psychological nature, which is my personal viewpoint as well, the categorical DSM diagnostic model will disappear just as rapidly as the model of psychoanalysis. Until one resolves this question, honestly and openly, the medical community is merely engaged in an extremely costly exercise of sketching boxes in sand, and then standing by powerless, allowing them to be blown away by social winds (McLaren, 2010).

A significant overlap can be perceived among DSM diagnostic categories, and one can reach a less or more desirable diagnosis for a patient based on individual evaluators. Even in the event of agreement, a number of professionals are voicing concerns regarding the fact that DSM diagnoses and ensuing conclusions aren't so beneficial. That is, the diagnosis they reach is nothing more significant than a tag based on a chance collection of symptoms. Mostly, DSM diagnoses fail to show the ideal strategy to employ, or even the particular treatment that is required. An increasing number of managed care organizations are demanding that professionals make diagnoses by utilizing the DSM, as well as offer systematic and reasonably- priced treatment. For instance, if a patient's symptoms satisfy major depression criteria, managed care demands to have details concerning what therapeutic procedure or medication must be administered for that particular diagnosis. There, unfortunately, seems to be no obviously useful link between DSM diagnosis, client treatment and treatment outcome. Despite the seeming consistency and accuracy, DSM diagnosis minimizes a key fact. It wasn't formulated on scientific bases; rather, it is founded on a unanimity development process, which is immensely political, partly democratic and resists scientific evidence. Just because a diagnostic system shows consistency does not prove it is valid, beneficial, and safe. A second key scientific reflection has been that highly similar behaviors and symptoms, which, under DSM diagnostic system, will lead to the same diagnosis, may have a number of wholly different causes. More notably, every individual cause may require a treatment that is entirely different. DSM diagnosis, further, fails to show physicians the precise treatment required for a particular patient. The differences among individuals and their social settings can drastically impact how their symptoms are manifested. A similar illness source can be manifested in vastly different behaviors and symptoms. Ethnicity and culture are potent moderators… READ MORE

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