09 Mar 2018

BY: Anna Keyter

Assessment / Treatment

Comments: No Comments

Critical perspective on Scientist-practitioner Model
Why a critical perspective on Scientist-practitioner Model?

With the DSM 5 changes, there is a renewed international reflection on the scientist-practitioner model also known as the medical model.   Mental and medical health professionals, as well as researchers, are familiar with the scientist-practitioner concept.  This article will take a moment to reflect on the true meaning of the scientist-practitioner in counselling.

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08 Mar 2018

BY: Anna Keyter

Assessment / Treatment

Comments: 1 Comment

Counselling Assessments using DSM-5 Diagnostic Tool

Counselling Assessments using DSM-5 Diagnostic Tool:

Main reasons for Counselling Assessments using DSM-5 Diagnostic Tool;

The DSM (also known as the Medical Model) stands for Diagnostic and Statistical Manual of Mental Disorders.  The latest addition is the DSM-5 and is distributed by the American Psychiatric Association.  Interestingly, there is a parallel classification system that was developed by the World Health Organisation, called the International Statistical Classification of Diseases and Related Health Problems (ICD-10).  Psychologists and Psychiatrists use these diagnostic tools to a large degree for medical insurance purposes.

DSM-5 Definition of Mental Health

A mental disorder is a syndrome characterised by clinically significant distur­bance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes un­derlying mental functioning. Mental disorders are usually associated with signif­icant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily be­tween the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above.

Various Criticisms of the DSM-5

Not Focused on Culture

Renato Alarcón from the Department of Psychiatry and Psychology, Mayo Clinic College of Medicine (1), highlighted the limitations of current diagnostic practice.  Criticisms include the relevance of culture during diagnosis.  He mentions that the cultural content should be taken into account during psychiatric diagnosis and the main, well-recognised cultural variables, including adequate family data, explanatory models, and strengths and weaknesses of every individual patient should be considered.

Diagnosis

Furthermore, Professor Winfried Rief (2) is concerned that the DSM is a “profit-making, lucrative franchise for the APA.”  What is concerning is that 25% of the American population qualifies for a psychiatric diagnosis yearly.  In addition, 50% will be diagnosed with a psychiatric disorder in their lifetime.   By defining milder conditions in the DSM-5, it distracts from attending to the severely mentally ill.

Stigma

Ben-Zeev, Young and Corrigan (3) published a paper on the stigma associated with mental illness.  They found that a psychiatric diagnosis can have devastating effects on the lives of mentally unwell people, their families and carers.  Whats more, they highlighted three types of negative outcomes (1) public stigma (2) self-stigma, and (3) label avoidance.

In defence of the DSM

Frances and Widiger (4) describe the DSM-V as the best current tool for diagnosis.

Our classification of mental disorders is no more than a collection of fallible and limited constructs that seek but never find an elusive truth. Nevertheless, this is our best current way of defining and communicating about mental disorders. Despite all its epistemological, scientific and even clinical failings, the DSM incorporates a great deal of practical knowledge in a convenient and useful format. It does its job reasonably well when it is applied properly and when its limitations are understood. One must strike a proper balance.

So where to from here?

Whilst not all counselling professionals focus on the DSM-5 criteria, it will remain the main diagnostic tool for many psychologists and psychiatrists for years to come.  Medicalising mental well-being is a major concern of the DSM-5.  In practice, the DSM-5 should be treated as a tool rather than be-all and end-all.  When using the DSM-5 as a diagnostic tool, be mindful of the long-term effects it can have on people.

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 References

(1) Culture, cultural factors and psychiatric diagnosis: review and projections

(2) DSM-5 – Pros and 

(3) DSM-V and the stigma of mental illness

(4) Psychiatric Diagnosis: Lessons from the DSM-IV Past and Cautions for the DSM-5 Future

DSM-5 

 

 

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