The dsm is politically and financially motivated and it’s frustrating to have to work within its constraints. Hope y’all are ready for a wall of text.
“What’s more, the DSM remained culture-bound and unable to cope with the complexities of gender and ethnicity in a multicultural world. […] But the DSM clearly wants to shape the wider practice of psychiatry.There is no ICD equivalent of the DSM casebook, which shows how the DSM can be used in diagnosis and treatment. Neither is the ICD implicated in the jostling between pharmaceutical companies, the health insurance industry and the psychiatry profession, as each haggles with the other over the existence or the extension of particular illness categories.Nor is the ICD a cash-cow for the WHO, unlike the DSM, which is a highly profitable enterprise. Indeed, the DSM is most certainly not disinterested.”
- Two visions for understanding illness: DSM and the International Classification of Diseases
“Epistemologically, the expert group concluded that mental disorder categories should not be treated as natural kind categories but as constructs that have a causal impact on those who are classified. Sociologically, the group observed that diagnostic classifications tend to legitimise organisational structures and protect psychiatry from pressures to change. Moreover, the literature suggests that a biomedical approach does not, as hoped, reduce stigma and discrimination. Clinically, the group concluded that common diagnostic categories lack validity, reliability, and predictive power. Additionally, these do not tally with new conceptions of health, defined by the ability to adapt despite biopsychosocial obstacles.”
- Belgian Superior Health Council advises against the use of the DSM categories
I’ve always been a big believer in case formulation over diagnosis.
“Formulation can be defined as the process of co-constructing a hypothesis or “best guess” about the origins of a person’s difficulties in the context of their relationships, social circumstances, life events, and the sense that they have made of them. It provides a structure for thinking together with the client or service user about how to understand their experiences and how to move forward. Formulation draws on two equally important sources of evidence: the clinician brings knowledge derived from theory, research, and clinical experience, while the service user brings expertise about their own life and the meaning and impact of their relationships and circumstances. […] Unlike diagnosis, formulation is not about making an expert judgement, nor is it based on deficits. Instead, a best-practice formulation draws attention to the service user’s resources and strengths in surviving what are nearly always very challenging life situations. Most important, and in contrast to psychiatric diagnosis, psychological formulation approaches all expressions of distress with the assumption that “at some level it all makes sense” (Butler, 1998, p. 2). From a formulation-based perspective, the work of every mental health professional, whatever their training, should be based on this principle: that however unusual, confusing, risky, destructive, overwhelming, or frightening someone’s thoughts, feelings, and behaviors are, there is a way of making sense of them. The central task of all mental health professionals is to work alongside service users to create meaning out of chaos and despair. Formulation is a powerful and effective way of doing this. “
- Psychological Formulation as an Alternative to Psychiatric Diagnosis
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