A. The
Diagnostic and Statistical Manual (DSM), published by the American Psychiatric
Association, was designed to provide a clear description of each diagnostic
category so that clinicians and researchers could learn, communicate about and
treat individuals in a consistent and effective way. The intent was to define a
given disorder by listing its specific symptoms or behaviors so that it is
distinguished from every other disorder.
Though
the Diagnostic Manual has been criticized in a variety of ways over some period
of time, it has had great influence in the mental health field. Insurance
companies and the pharmaceutical industry rely on it to monitor the
appropriateness of treatment. Clinicians must use the Diagnostic Manual in
order to submit insurance claims for clients.
The
Diagnostic Manual includes five areas of evaluation. The first one includes all
of the psychological diagnostic categories except for personality disorders. Number
two includes personality disorders (in grained personality patterns such as
paranoid, schizoid, narcissistic) and mental retardation. Number three lists general
medical conditions which may be affecting the client’s functioning. Number four
describes interpersonal and environmental factors or problems (such as job
loss, marital problems). Number five is called the Global Assessment of Functioning (GAF ) which is a measure of the individuals
over all level of functioning.
Mental
disorders can not be as precisely diagnosed as heart conditions or cancer but
the Diagnostic Manual does provide a framework, including a range of behavior
or symptoms, to assist clinicians in evaluating a client’s mental and emotional
functioning.
There are
problems with this, however. Human nature and personality are complex,
involving mind, body, spirit and emotions. It is difficult to pigeon hole or
label individuals and this is often done after just a fifty minute evaluation.
Also labels can change. We grow, learn and mature through out life and often
our past labels no longer fit us.
It is sad
when someone has been given a mental health diagnosis incorrectly but it
follows them in their medical chart endlessly or when they have changed and
this change is not recognized. Also, because of the need to qualify for
insurance coverage, the tendency is to use the diagnosis that will give the
most coverage. This can encourage giving a more severe diagnosis than
necessary.
In the
April 2001 issue of Social Work, Dr.
Dennis Saleebey suggests another problem, the need for a sixth category detailing
Diagnostic Strengths. The Global Assessment of Functioning (GAF ) defines competent functioning mainly as
the absence of symptoms. In Saleebey’s
suggested sixth category of Diagnostic Strengths clinicians would list the
strengths of each patient. This would include skills, talents, virtues, interpersonal
abilities, family support, a strong faith and so forth.
This idea
is supported by the work of Daniel Goleman in his book Emotional Intelligence in which he gives evidence that
characteristics such as self-awareness, persistence, empathy, and optimism
produce successful, happier and healthier lives.
The
Diagnostic Manual is an essential and valuable tool in the field of mental
health. I agree with Saleebey, however,
that there is a need to include the patient’s strengths in the evaluation. Too
often the mental health field focuses on what’s wrong rather than what’s
positive or valuable in a person’s life or make up.
When choosing a therapist, find one who will recognize your strengths in the midst of your symptoms and problems. Pay attention also to your own strengths. As I said before in a prior post, choosing a therapist with a similar world view is important no matter what. This is especially true if your faith is very important to you or if you want to explore spiritual issues. To do otherwise is like trying to communicate in two different languages.
When choosing a therapist, find one who will recognize your strengths in the midst of your symptoms and problems. Pay attention also to your own strengths. As I said before in a prior post, choosing a therapist with a similar world view is important no matter what. This is especially true if your faith is very important to you or if you want to explore spiritual issues. To do otherwise is like trying to communicate in two different languages.
Blessings,
Dottie
“Plans go
wrong for lack of advice; many counselors bring success. Proverbs 15:22 NLT
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