In a day and age where diagnosing clients remains key to our work as therapists, and to our training as diagnosticians, many clinicians may have mixed feelings about assigning a diagnosis to clients in treatment. As my knowledge about (and experience in) the field continues to develop, I am quickly learning that the manual we use to diagnose our clients is simultaneously hated, yet needed, by many mental health providers in the field. The practical purpose of the DSM-IV TR (Diagnostic and Statistical Manual of Mental Disorders- Fourth edition/Text Revision) is to be able to clearly identify and categorize symptoms. Originally created by the American Psychiatric Association in 1952, the DSM enables mental health providers to utilize the manual to better understand a client's potential needs, in addition to being a tool for assessment and diagnosis.
However, this immensely informative tool is also controversial, in the sense that it may tend to diagnose behaviors that are not universally seen as ‘disordered’; in addition, it lacks cultural sensitivity, as some behaviors in a particular culture may be seen as ‘different/abnormal/deviant’ by another culture. For example, in discussing the difference between ‘depression’ and grieving the death of a loved one: the DSM recognizes the sadness and low mood that accompanies Bereavement, and does not list it as an official disorder. Although, if the depressed mood following the death of a loved one persists longer than two months, a clinician should consider assigning a diagnosis of Major Depressive Disorder to the grieving client. This specificity seems to imply that two months is the appropriate- or normal- amount of grieving time. This poses as a conflict for me personally, and I have learned from clients of various cultural backgrounds that grieving for an extended period of time may be culturally expected in some cases.
After losing my best friend in a tragic motorcycle accident five months ago, I still feel as devastated and grief-stricken as I did the night that I found out over the phone. Am I only allotted two months to be depressed before my reaction to this event is viewed as ‘disordered’? When working with clients from non-American cultures, I have learned that most cultures have their own varying beliefs regarding mourning the death of a loved one- many of which are not time-limited. I have struggled to make sense of the specific qualifiers in the DSM, as I often find them vague or culturally-bound. I believe in the importance of utilizing the DSM as a diagnostic tool, although I fear the over-diagnosing or mis-diagnosing of clients that could result from overlooking cultural components of the client’s beliefs and values. While I continue to struggle with some of the viewpoints of the DSM, I constantly refer to it for information and could not work as a clinician without it. As the new Diagnostic and Statistical Manual of Mental Disorders- the Fifth edition- is planning to be published in March 2013, I remain incredibly curious of what changes and what, if any, cultural considerations may be taken into account in the new edition. It has been twelve years since the DSM has been revised, so I am intrigued to see what American cultural shifts will be reflected in the manual.
(Photo by the half-blood prince)
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