January 3, 2009

Diagnosis skepticism

On the website Mindhacks there is an interesting article on DSM-V, the American Psychiatric Association's diagnostic manual that defines mental illness: More on secrecy behind the new book of human troubles. Here is how Mindhacks cynically describes it:
"Diagnoses decided by an unelected committee in secret sessions that are legally prevented from discussing their work. Science marches on." Read more. Also read: New psychiatric diagnoses developed in secret, and Soft money in psychiatry muddies manuals, airwaves, and Against diagnostic checklists.
There is good reason to be skeptical about diagnosis of mental illness. Barry Duncan and Scott Miller, in their book The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy, have criticized psychiatric diagnosis, saying that it
  1. it lacks reliability, 
  2. it lacks validity, 
  3. it puts the blame on the client, and 
  4. it is often motivated by self-interest, fueled by greed, and blows with the winds of fashion.
Here is some background on diagnosis from a solution-focused perspective. Solution-focused practice does not use diagnosis. Milton Erickson, who was an important influence on the development of the solution-focused approach, did not believe in diagnostic labels. He inspired many therapists to leave diagnosis out of the therapy process and instead focus on goals and things that work. In the 1970's and 1980's, Steve de Shazer, Insoo Kim Berg and their colleagues from the Brief Family Therapy Center had a mission to find out what worked in therapy. In order to do this they started by identifying traditional elements of therapy and removing one element at a time from sessions. Then they observed whether the client outcome had been affected by the removal of this element. They discovered that analyzing and diagnosing problems could be removed from the therapeutic conversation without negative consequences for client outcomes.

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