Week 2 Discussion Response to Classmates
I NEED THIS 09/12/2020 BY 1PM
Please no plagiarism and make sure you are able to access all resources on your own before you bid. You need to have scholarly support for any claim of fact or recommendation regarding treatment. Grammar, Writing, and APA Format: I expect you to write professionally, which means APA format, complete sentences, proper paragraphs, and well-organized and well-documented presentation of ideas. Remember to use scholarly research from peer-reviewed articles that is current. Sources such as Wikipedia, Ask.com, PsychCentral, and similar sites are never acceptable. Each classmates document is attached so please respond separately.
Read your classmates’ postings. Respond to your classmates’ postings.
Respond to all colleagues on how to incorporate culturally sensitive practices into the diagnosis practice so that an individual or population is not marginalized intentionally or unintentionally.
1. Classmate (N. Kim)
The process of development of the DSM system of diagnosis
The many different classification systems that were developed over the past 2000 years have differed in their relative emphasis on phenomenology, etiology, and course as defining features. The various classification systems were developed over the past 2000 years including numerous diagnostic categories. Work groups that generated a large number of papers, monographs, and journal articles were formed to create a research agenda for the fifth major revision of DSM (American psychiatric association, 2013). The APA first published DSM in 1844, and it functioned as a statistical classification of mental patients (American psychiatric association, 2013). DSM was operated as an element of the full U.S. census. APA formed the DSM 5 task force to begin revising the manual as well as 13 work groups focusing on various disorder areas, and the current DSM-5 offers guidelines for diagnoses that can inform treatment and management decisions.
The development of the DSM 5
It is somewhat surprising that homosexuality was considered as a mental illness, and was de classified as a mental illness in 1973. I have quite a few friends who are LGBT, and they seem to be just like the people who are heterosexual. The reasons that homosexuality was declassified were that many homosexuals are satisfied with their sexual orientation and demonstrate no generalized impairment (Toscano & Maynard, 2014). Moreover, it is quite surprising that DSM 5 includes an updated version of the Outline, an approach to assessment using the Cultural Formulation Interview (CFI) (American psychiatric association, 2013).
How the classification system of disorders in the DSM 5 has pathologized
The DSM can be treated as a living document, changing with clinical work. Gender dysphoria can be an example of DSM being influenced by societal critics. A major problem with pathologizing gender-atypicality is that there is a lack of consensus on gender appropriateness (Langer & Marint, 2004, p12). Anyone can struggle with the life stressors when formulating a new identity. It is important for counselors to find out if the client falls under criteria for a GD diagnosis and not suffering from an intersex condition, fetishism, somatoform disorder, or other disorder (Byne et al. 2012).
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Byne, W., Bradley, S.J., Coleman, E., Eyler, A.E., Green, R., Menvielle, E.J., Tompkins, D.A. (2012). Report of the American Psychiatric Association task force on treatment of gender identity disorder. Archives of Sexual Behavior, 41(4), 759796. doi:10.1007/s10508-012-9975-x
Langer, S.J., & Martin, J.I. (2004). How dresses can make you mentally ill: Examining gender identity disorder in children. Child & Adolescent Social Work Journal, 21(1), 523. doi:10.1023/B:CASW.0000012346.80025.f7
Marion E. Toscano & Elizabeth Maynard (2014) Understanding the Link: Homosexuality, Gender Identity, and the DSM, Journal of LGBT Issues in Counseling, 8:3, 248-263, DOI: 10.1080/15538605.2014.897296
2. Classmate (L. Shave)
Mental illness and associated symptoms have been prevalent for many years. In the 1800s, in the United States, professionals identified a need to begin to quantify and classify mental health disorders and to collect and to begin to interpret statistical information. As information was collected and observed in individuals who presented with mental health symptomology, categories of disorders based on symptomology, behavior, personality, and biological factors became classified and organized in a manner to create reliable diagnoses. This led to the development of the DSM-II. The DSM-III was developed and published in 1980 with adding more specific diagnostic criteria and developing a diagnostic system of five axes. The five axes are as follows: Axis I provides the mental health diagnosis, Axis II provides the diagnosis as to personality disorders and mental retardation (intellectual disability,) Axis III provides any medical conditions that the individual may have that can affect their mental health disorder or impact the disorder, Axis IV produces specific environmental or psychosocial stressors that the individual is experiencing at the time of diagnosis and Axis V provides a number as to the individuals level of functioning on the Global Assessment of Functioning for an adult, or from the Childrens Global Assessment of Functioning if the individual is a child. The updated version of the DSM was developed to provide a more definitive diagnosis and substantiating the diagnostic criteria. The DSM-IV was published in 1994 after finding that the DSM-III demonstrated that some of the diagnostic information was not clear. This version of the DSM was developed with having mental health professionals and organizations review the literature and establish a firmer and more concrete basis to substantiate the changes. The DSM-5 was published in 2013 after many experts around the world created the manual based on evidenced-based findings to improve the ability to diagnose individuals and to facilitate treatment services in a variety of settings.
Based on the history of the development of the DSM and intermittent updates as to the information provided in this manual until the most recently published of the DSM-5, I learned that the complexity of providing accurate diagnostics to be quite a challenge. Even though there have been revisions, I believe that in the future, there will be continued revisions indicated due to the complexity of an individual, the environment that surrounds the individual and the changes that continue to occur in this country and around the world. Based on multiple factors that are difficult to take into account at the time of the development of the DSM-5, since that time, and in the future, there are other issues or potential effects that have not been fully explored or researched. Some of these factors include cultural issues, biological and neurological factors, and unpredictable events that can arise and continue to impact others.
One example of how the classification system of mental disorders has pathologized individuals with mental health issues remains the stigma attached to mental illness. There have been improvements with educating the general public at a local level and throughout the country with the use of education, however, the stigma associated with mental disorders remains evident and remains a barrier for individuals seeking treatment, leading to feeling a sense of shame, and being focused on by others, whether it be family or individuals in the community. People seem to lack the insight that a mental health diagnosis is something that can be treated successfully and that a mental health diagnosis is not necessarily a life-long label that an individual possesses. When an individual has a mental health diagnosis, the illness is a part of the person and not the entire person. In addition, a mental health diagnosis can change over time and have a sense of fluidity.
3. Classmate (T. Roberts)
Main Discussion Post
The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM5; American Psychiatric Association [APA], 2013) is the most used text for researchers and clinicians. This book was finalized and published in 2013 with about 13 work groups that focused on various disorder areas. The DSM- 5 helps determine diagnoses for people who suffer from mental disorders. Determining an accurate diagnosis is the first step toward treating a client appropriately. It provides a common language for clinicians to communicate about their patients and establishes consistent and reliable diagnoses that can be used in the research of mental disorders. The DSM-5 also provides a common language for researchers to study the criteria for potential future revisions and to aid in the development of medications and other interventions (APA, 2013).
One thing that surprised me when it comes to the development of the DSM-5 is how many different revisions it has gone through throughout the many years it has been developed. When it comes to the DSM 5 it is clear and obvious that is an educated guess on symptoms that a person may suffer from. Not everyone is the same and will experience all or possibly none of the symptoms. This does not disqualify a client from not having the mental disorder. Another thing that surprised me is how symptoms are remarkably similar to other disorders. When it comes to diagnosing clients, it is okay for a client to experience a symptom one week and in a month that client no longer has that same experience.
One example of how the classification system of disorders in the DSM-5 has marginalized diagnosed populations currently is because they treat some disorders as insignificant. For example, suicide is a current ongoing issue today. Suicide is not considered to be apart of the DSM-5 because many people who commit suicide do not have prior mental disorders (Oquendo & Baca-Garcia, n.d.). Although schizophrenia, alcohol use disorder or posttraumatic stress disorder are all associated with significant risk for suicide attempt or death it is not seen as a separate diagnosis.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Oquendo, M. A., & Baca-Garcia, E. (n.d.). Suicidal behavior disorder as a diagnostic entity in the DSM-5 classification system: advantages outweigh limitations. WORLD PSYCHIATRY, 13(2), 128130. https://doi-org.ezp.waldenulibrary.org/10.1002/wps.20116
Required Resources
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
Section III, Cultural Formulation
Appendix, Glossary of Cultural Concepts of Distress
Kress, V. E., & Paylo, M. J. (2019). Treating those with mental disorders: A comprehensive approach to case conceptualization and treatment (2nd ed.). New York, NY: Pearson.
Chapter 2, Real World Treatment Planning: Systems, Culture, and Ethics
Hargett, B. (2020). Disparities in diagnoses: Considering racial and ethnic youth groups. North Carolina Medical Journal, 81(2), 126-129. doi:10.18043/ncm.81.2.126
Toscano, M. E., & Maynard, E. (2014). Understanding the link: Homosexuality, gender identity, and the DSM. Journal of LGBT Issues in Counseling, 8(3), 248263. doi:10.1080/15538605.2014.897296
Aftab, A. (2019). Social misuse of disorder designation, part 1: Conceptual defenses. Psychiatric Times. Retrieved from https://www.psychiatrictimes.com/dsm-5/social-misuse-disorder-designation-part-i-conceptual-defenses
American Psychiatric Association. (n.d.). DSM history. Retrieved December 10, 2019, from https://www.psychiatry.org/psychiatrists/practice/dsm/history-of-the-dsm
Spiegel, A. (2004). The dictionary of disorder: How one man revolutionized psychiatry. The New Yorker. Retrieved from https://www.newyorker.com/magazine/2005/01/03/the-dictionary-of-disorder
Required Media
Walden University (Producer). (2019c). Social misuse of diagnosis: Pathologizing marginalized populations. Minneapolis, MN: Author.
Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD
2020 Walden University 1
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
Candace McLain, PhD
Program Transcript
[MUSIC PLAYING]
CANDACE MCLAIN: Hey everybody, Dr. Candace McClain here. I am a core faculty at
Walden University in the clinical mental health program. I’m here to talk to you just for a
very brief couple of moments today about avoiding pathology and diagnosis
assessment and treatment planning. Part of how this came about for me was a few
years ago, I really had this epiphany that all of this avoiding, pathologizing, avoiding,
biases, really starts with understanding our counselor identity.
And so I think it’s important to look at, OK, what is my role and responsibility in my
identity as a counselor first and foremost. And if we look at the roots of how counseling
really got started, it was really based more on a developmental model, and a model of
wellness and health, versus some of the other fields who were more medical model and
built on diagnosing and looking for pathology. And so I think it’s important to really
differentiate and understand, as counselors, our identity and how it’s different than other
fields.
And really how that also dovetails in to the next topic is that our identity as counselors is
crucial in understanding our own world view. Now, sometimes I’ll ask students, what’s
your world view? Are you aware of your world view? And they look at me, like, what’s
that? Well, we have heard that word thrown around quite a bit, worldview. But I think it’s
really important that we continue to analyze, reflect, and have self awareness of what
that means.
And so when we look at our own world view, we’re really looking at our values, ideas,
thoughts, and beliefs about ourselves, others, and the world that we live in. And that
includes the biopsychosocial cultural spiritual model as well. And so you can’t really help
but when you’re analyzing and reflecting on your worldview, having some kind of self-
awareness of cultural humility as well in that process. And so it often involves a lot of
self reflection, introspection, but also dialogue and conversations that are very authentic
and very courageous with colleagues, peers, supervisors, faculty, and even family
members.
And so I think that that’s a really important piece I want to encourage everyone to look
at. Ironically enough, according to the ACA Cross-Cultural Competencies and
Objectives, there are three core categories that are expected of counselors in order to
have these competencies related to culture and awareness. And the three sections all
involve this awareness that we need to have about our attitudes and beliefs, and that’s
also dispositional, right. And then also the knowledge and the skills under each area.
And the three areas ironically, like I said, are awareness of our own worldview is the first
one. The second one is awareness of our client’s worldview. And the third one is
Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD
2020 Walden University 2
culturally appropriate interventions and strategies. If we are indeed doing those three
areas; exploring, and having self-awareness, self-understanding, courageous, authentic
conversations with other people about our attitudes and beliefs, and we’re working on
the knowledge and the skills, then we can prevent and avoid pathologizing in our
clients.
Many years ago, I worked in residential treatment with all adolescent girls, and I was
leading a transitional living workshop in which the focus was success upon transitioning
from foster care or residential care onto your own as a client into the world. You know,
being discharged.
And our topic for that week was actually looking at trade schools and college and how to
find a career. And we got about halfway through our group, and I had one of my clients,
who is Native American, Lakota, from South Dakota, and who had grown up on the
reservation. She raised her hand and she asked, well what if we don’t want to go to
college or a trade school? What if that’s not really defined as success in our family and
to us?
And for the first time, I paused and just said, wow, you’re right. That’s a great question.
And internally, went home– um, actually went after work and processed with colleagues
how I felt very convicted that by assuming that this was the definition of success for all
of our clients that that was very not cultural competent at all. And it was imposing our
world view onto our clients. And could potentially have been damaging if we hadn’t
rectified that.
In that space, I also recognized that some of the other counselors had an idea that was
different. And that was, well, no, they need to do X, Y, and Z to be successful. And it’s
not normal or right, if you will, if all they want to do is be an artist, or make crafts, or
weave rugs. And that was very, very eye opening for me, because to see the
discrepancy of how something so simple as having a blind spot of our own as
counselors, and being biased, and not being aware of our world view and our clients
worldview could turn into something like pathologizing our clients. It’s very scary, but
also eye-opening for me.
So I think that that’s just one brief example. But I think the best way to look at it is if
you’re doing, ethically, what you should be doing and following the codes, and seeking
and going above and beyond those codes by looking deeper at your own personal and
professional growth in dispositions, character, skills, and knowledge, then you’re going
to prevent, hopefully, many of those instances of pathologizing clients.
Whether it be religion, cultural pieces of ethnicity, sexual orientation, or whatever the
differences are and the diversity is, it’s our responsibility to be culturally competent and
look at and have that awareness at all times. And then be challenging ourselves with
collaboration and supervision. So, I hope that that’s helpful. I look forward to hearing
and learning about all of your world views, and see how you guys wrestle with these
things while you’re in training. It’s very exciting. Take care.
Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Candace McLain, PhD
2020 Walden University 3
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
Candace McLain, PhD
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Echo/Cultura/Getty Images Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Renee Anderson, PhD
2020 Walden University 1
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
Renee Anderson, PhD
Program Transcript
RENEE ANDERSON: Hi, I’m Dr. Anderson. I’m a licensed professional clinical
counselor and I’ve been practicing for over 14 years. During this time, I’ve used a
couple of the DSMs. I use the current DSM 5, and I’ve used the previous version, the
DSM-IV-TR. And while the DSM is a great tool, it needs to be used with cautionary
measure and viewed within the context of social norms and current times.
Some diagnoses have pathologized certain groups of people. Certain marginalized
groups of people. For example, historically, homosexuality was listed as a diagnosis
which pathologized people who identify as gay and lesbian. In today’s DSM 5, there’s is
a diagnosis called premenstrual dysphoric disorder, which pathologizes women and
women’s natural biological processes.
The diagnosis implies that women should be able to control the hormone and chemical
production and levels in their bodies. Another diagnosis is gender dysphoric disorder
which can pathologize transgender people. For example, I had a client in the prison who
was a transgender female to male. He had been taking hormones for years, he had
identified as male, he looked male. For all intents and purposes, he was male.
However, the prison’s medical department formulary didn’t cover hormones. So he
needed that diagnosis so that he could receive his hormone medication while in prison.
While the DSM might have some diagnoses that pathologized people, it can also do
some good, like getting that person, my client, the hormone medication. Also, because
the DSM works under a medical model, we need to provide a diagnosis in order to be
reimbursed for treatment.
For example, could you imagine if a medical doctor was treating a patient for weeks, or
months, or even years without having diagnosed the problem? That medical doctor’s
license would probably be called into question. We often need a diagnosis. We need to
identify the problem in order to provide a solid treatment plan in order to find a good
direction for treatment. With all of that being said, I just want to emphasize that it’s just
important to view the DSM through a social context and with measured caution.
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
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Echo/Cultura/Getty Images Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Sue Banks, PhD
2020 Walden University 1
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
Sue Banks, PhD
Program Transcript
SUE BANKS: Hello, my name is Dr. Sue Banks, and I am a core faculty member at
Walden University in the School of Counseling and clinical mental health counseling
program. I’ve been asked to speak about how diagnosis has historically been used to
pathologize marginalized populations. I think that in the past, many Americans were
able to hide mental illness. But today, as jobs become more demanding, our schools
become more unsafe, and life just gets in the way, more and more people are just
unable to manage their anxiety, to manage their depression, and overall dysfunction.
So as more people seek care, then we’ve seen an increase in the diagnosis of mental
disorders over, let’s say, the past 30 years or more. Researchers also argued that the
DSM has made it easier for individuals to qualify for mental illness, or to meet the
criteria for mental illness.
We’ve also seen an increase in pathologizing normal behavior. I’m reminded of this with
the increase of pharmaceutical commercials on TV. When I think about pathologizing
marginalized populations, I have to discuss what pathology means to me. Pathologizing
is the practice of seeing normal behavior or seeing common symptoms in certain
communities as a disorder.
I also see pathologizing as a means of over-diagnosing certain behaviors or conditions.
And also an excessive use of psychotropic medications. When large numbers of people
in certain areas, particularly lower socioeconomic areas or urban areas have particular
diagnoses, then I think about pathologizing.
I also believe that this causes us to miss really understanding the experiences of the
groups. And we miss how to effectively treat the condition for particular groups.
Examples of this can be seen in the increasing numbers of children diagnosed with
mental disorders like attention deficit hyperactivity disorder, or ADHD, and also adults
diagnosed with schizophrenia and schizoaffective disorders in urban areas.
Now I’m sure that there may be additional considerations related to pathologizing
behavior, and it might even be necessary in some areas or communities. Frequently, I
attend presentations by pharmaceutical representatives who consistently present data
showing that clients are three to four times more likely to be misdiagnosed with mental
disorders. And, of course, misdiagnosis causes them to receive inappropriate
medication treatment.
This is where the problem lies for me. Not only do clients receive improper medication
treatment when they’ve been misdiagnosed, but they also receive inadequate
psychosocial treatment like counseling and other psychosocial interventions. What I
want to emphasize is the importance of all counselors having a common understanding
of assessment.
Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Sue Banks, PhD
2020 Walden University 2
Assessment is a valuable tool that supports diagnosis, but it should never be used in
isolation. And certainly the results of one assessment should never lead to a diagnosis
or medication treatment. Some main purposes for using assessments include to gather
information about client in order to make an accurate diagnosis, to formulate an
effective course of treatment for the client to evaluate the client’s progress during
treatment, and also to support a request for additional services for the client.
I believe that understanding the challenges of assessing and diagnosing children and
adults, as well as staying abreast current trends in assessment and mental health
intervention, will allow us as counselors to serve clients from a best practice approach
to mental health care. So thank you for your time.
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
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Echo/Cultura/Getty Images Social Misuse of Diagnosis: Pathologizing Marginalized Populations: Rachel ONeill, PhD
2020 Walden University 1
Social Misuse of Diagnosis: Pathologizing Marginalized Populations:
Rachel ONeill, PhD
Program Transcript
[MUSIC PLAYING]
RACHEL O’NEILL: Hi, everyone. I wanted to talk with you about a population that has
historically been marginalized by diagnosis. And that is the population of individuals who
identify as transgender, or gender nonconforming or non-binary, genderqueer,
individuals who simply feel like the gender assigned at birth does not correspond with
the gender that they feel.
Historically, individuals who felt that way were diagnosed with something that was called
gender identity disorder. In the most recent edition of the DSM, DSM-5, that terminology
has changed. And now individuals who feel that they’re in the incorrect gender and feel
clinically significant distress related to that are diagnosed with gender dysphoria. This is
an important distinction because instead of pathologizing individuals for feeling that
they’re in the wrong gender, it removes that pathology and moves to a space of only
diagnosing if the individual experiences that clinically significant distress related to being
in the incorrect gender.
I do want to mention that for many people who are meeting criteria for gender dysphoria
or not but are transgender individuals, individuals who are non-binary, in order to obtain
some of the services that they might want, in particular hormone replacement therapy,
surgical treatment for their gender dysphoria, they do tend to have to have the diagnosis
of gender dysphoria. So in many ways, gender dysphoria as a diagnosis is a gate that
the individual has to go through in order to qualify for some of these other services.
So for example, if you find yourself in a position where you’re working with somebody
who identifies as perhaps a transgender woman and wants to begin to move forward
with seeking hormone replacement therapy, hormone suppression therapy, or perhaps
having some surgical procedures, typically any medical professional will require
documentation from a mental health professional supporting that this individual does
meet criteria for gender dysphoria. So although the diagnosis in and of itself can be
pathologizing to a population that does not need to pathologize– there’s nothing
inherently wrong with identifying as transgender. There’s nothing inherently wrong with
identifying as gender nonconforming– the diagnosis also opens doors.
And so it does, in some ways, become a necessary evil for individuals who may want to
seek those treatments. I think that’s where our role as mental health professionals is to
help folks realize that we’re not diagnosing. We’re not pathologizing the fact that they
may identify as transgender. Rather we’re talking about the dis
