In this issue
"The Future of Diagnosis — Ethics, Social Justice, and Alternative Paradigms"
By Madeline Brodt, MS
It is easy to feel defeated or hopeless in our current mental health care system. It can feel like everything is related to the Diagnostic and Statistical Manual of Mental Disorders (DSM) and justifying one's clinical work to insurance companies is something one spends a tremendous amount of time on. Div. 32 believes that alternatives are possible and this year at APA through the symposium “The Future of Diagnosis — Ethics, Social Justice, and Alternative Paradigms,” several presenters provided information about this future.
- Lisa Cosgrove, PhD, and co-authors began the symposium by identifying issues in the current diagnostic conventions and how it impacts client care. It was emphasized that the current conflicts of interest that have shaped the DSM have created problematic prescribing practices utilizing the drug narrative.
- Sarah R. Kamens, PhD, and several colleagues then shared a framework with which to design and evaluate alternative diagnostic systems. The presenters provided a comprehensive set of suggestions designed to fully realize these systems moving from purpose, to design, structure and scientific evaluation. These principles were related to current diagnostic systems including the DSM and National Institute of Mental Health's (NIMH) research domain criteria (RDoC).
Several presenters then illuminated how alternative systems look currently and how these may look in the future.
- Anthony Pavlo, PhD, and co-authors provided guiding principles for creating and utilizing recovery oriented understanding of people to assist in creating a collaborative understanding of the presenting problems. To assist in better understanding these principles qualitative data was presented on the client and clinician's feelings about this model and a DSM based diagnosis. Analysis showed that the recovery oriented approach was preferred by both client and clinician.
- Jeffrey Rubin, PhD, also presented on a potential classification system, Classification and Statistical Manual of Mental Health Concerns (CSM). CSM focuses on mental health concerns as identified and defined by the person served. The CSM was illustrated with several case examples that provided further understanding of how this alternative is a more human centered and culturally sensitive practice.
- Peter Kinderman, PhD, concluded the program by providing information about the British Psychological Society's (BPS) method of diagnosis and conceptualization that emphasizes phenomenological approaches to the problems clients present with. The presentation focused on providing examples of case formulations and it's applications to forensic evaluations thus assisting psychologists in feeling able to utilize alternatives in a large system.
Unfortunately, there were several participants who were unable to share their analyses with the convention attenders. Their work in this area is something to be commended and hopefully will be shared in an alternative venue.
A unique aspect of this symposium was the conversation hour that occurred directly after the symposium where both attendees and presenters were able to engage in an open dialogue about the issues discussed. Conversation surrounded how to incorporate lived experiences of those with mental health problems in these conversations and diagnostic system in addition to moving away from an expert role. The discussion also focused on the practical impacts of not adhering to a DSM or International Classification of Diseases (ICD) diagnostic system such as legal or other systemic complications.
We hope that all psychologists, and in particular Div. 32 members, continue to work against the DSM and look to alternative modes of practice that do not condone conflicts of interest and pathology, but rather the lives and experiences of the people who come to us as psychologists.