Experimental Psychopathology - week 2

This week's readings addressed a variety of issues related to diagnosis, diagnostic criteria, and diagnostic methods, primarily via a review and critique of the methods existing in past and present iterations of the DSM. Below are some of my thoughts on parts of these readings:

Allen, 1998 DSM-IV

Allen notes early in his article that mental disorders include “risk of… losing an important freedom.” (Allen, p. 29)

This is a very interesting twist on the idea of diagnosis that I hadn’t considered. Most restrictively, this stipulation seems to involve inclusion of those who may engage in conduct that would lead, explicitly, to the loss of such a freedom (e.g. pathological lewd behavior in public leads to arrest, so this is a characteristic of a disorder). However, what of the other interpretations of this language? Did Rosa Parks qualify for a mental disorder because refusing to move from the front of a bus was considered illegal at the time (and would therefore lead to the same consequence as the purveyor of public profanity)? Would a man who chooses to move from America to an Islamic society (e.g. Saudi Arabia, Egypt, Afghanistan) with more restrictive social laws be considered potentially disordered by virtue of putting himself at risk for losing some of his freedom of speech? Is an advocate of gun control at risk for being disordered because he is advocating the abdication of his Second Amendment rights? Can the American populace of late, subjected to more intrusive scrutiny by way of large-scale Executive wiretapping, be said to qualify for potential diagnosis because of the cessation from its “important freedom” from warrantless search?

I bring up these questions (the latter of which I recognize to be more a vehicle for political flashpoint than true conjecture) by way of hypothetical inquiry, but the underlying point remains: many diagnostic criteria, as pointed out by Szaz, are broadly culturally enmeshed. The implications, then, for extensive, world-wide reliability for DSM diagnoses, seem rather sticky. Though mental disorders are to “reside within an individual,” a “caveat [which] is supposed to prevent … applying them to individuals whose values or beliefs differ from those of the majority,” (Allen, p. 30) some of the above circumstances could be argued to exist as “internal problems.” It seems, then, that a more consistent system of validity verification (either via increased understand of etiology through pathological mechanism, as argued in the Persons article) would be of utmost value to future iterations of the DSM. Understandably, this could splinter the DSM even further into many (many) more monothetic diagnostic categories. However, it could be argued that this level of breakdown (augmented somewhat by the clear value of the multiaxial approach) would more closely approximate the wide variety of mental disorders that actually exist, as supported by the notation by Widiger and Clark (p.951) that “the not-otherwise-specified category is the most frequently provided diagnosis in general clinical practice, perhaps because the nomenclature is currently inadequate in its coverage.”

Persons, 1986, Psychological Phenomena vs. Psychiatric Disorders

Given the question presented (psychological phenomena vs. classified disorders), it seems that the natural follow-up question lies in the practical functional utility of either. It is true that, as Persons argues, Psychological phenomena are both more descriptive and more precise than psychiatric disorders. However, I would imagine that a strong reason for doing research into Psychiatric Disorders is the prevalence of their use (i.e. their representativeness of the actual classifications of actual patients who show up for evaluation or treatment). Though it would be very interesting (academically) to learn more about the nature of underlying phenomena, applying these finding would be uniquely difficult given that (as Allen mentions) we do not have a dimensional approach to diagnosis; further, changing the diagnostic paradigm such that we do focus more on dimensions (e.g. psychiatric phenomena as diagnostic dimensions) would put an undue burden on clinicians to administer even (and ever) more extensive and intricate evaluation batteries to capture the nuances of these dimensions.

It seems, then, that the real utility would lie in the fusion of the two: research into psychological phenomena as they present in individuals given Psychiatric diagnoses. It is fascinating that, for instance, “patients with nonschizophrenic diagnoses may have overt thought disorders,” (Persons, p. 1253) but a more useful examination (for those diagnosing and treating those labeled “schizophrenics”) would look at the nature and presence of thought disorders in the schizophrenic population and how to more easily assess their impact. This, then, could lead to the kind of improved diagnostic classification that Persons talks about (p. 1257), while at the same time addressing the real and present needs and concerns endemic to the population as we currently understand it.