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Epistemological Issues in Diagnosis and Assessment

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Critical Thinking in Clinical Assessment and Diagnosis

Part of the book series: Essential Clinical Social Work Series ((ECSWS))

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Abstract

This book begins with a thoughtful exploration of two fundamental questions that underlie all clinical decisions. First, what exactly is a “mental disorder,” as opposed to other kinds of suffering or maladaptive behavior that we would call non-mental disorders? What makes a disorder specifically mental? And second, on what do we base these definitions and distinctions? What do we consider reliable (and unreliable) sources of knowledge, and what are some of the pitfalls in our assumptions about what we “know” and how we’ve come to “know” it? Common cognitive errors are explored, along with their consequences. These include circular reasoning, the difficulty of determining threshold or cut-off point, assumptions about causality, and the problems inherent in mental heuristics such as anchoring and availability. The chapter then explores the role of labels and labeling theory, the aims and limitations of classification systems such as the DSM, and the challenge of trying to develop a way to think about mental disorder that is useful for both general purposes (to make predictions based on shared characteristics) and specific aims (to understand and help particular individuals).

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References

  • American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington, VA.

    Google Scholar 

  • Banzato, C. E. M., Mezzich, J. E., & Berganza, C. E. (2005). Introduction. Psychopathology, 38(4), 159–161.

    Article  Google Scholar 

  • Berganza, C. E., Mezzich, J. E., & Pouncey, C. (2005). Concepts of disease: Their relevance for psychiatric diagnosis and classification. Psychopathology, 38(4), 166–170.

    Article  Google Scholar 

  • Berner, E. S., & Graber, M. L. (2008). Overconfidence as a cause of diagnostic error in medicine. The American Journal of Medicine, 121(5A), S2–S23.

    Article  Google Scholar 

  • Berlin, S. B., & Marsh, J. C. (1993). Informing practice decisions. New York: MacMillan.

    Google Scholar 

  • Brown, J. F. (2002). Epistemological differences within psychological science: A philosophical perspective on the validity of psychiatric diagnoses. Psychology and Psychotherapy: Theory, Research and Practice, 75, 239–250.

    Article  Google Scholar 

  • Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66(1), 7–18.

    Article  Google Scholar 

  • Corrigan, P. W. (2007). How clinical diagnosis might exacerbate the stigma of mental illness. Social Work, 52(1), 31–39.

    Article  Google Scholar 

  • Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic Medicine, 78(8), 775–781.

    Article  Google Scholar 

  • Deleuze, G., & Guattari, F. (1996). What is philosophy? New York: Columbia University Press.

    Google Scholar 

  • Erikson, K., & Kress, V.E. (2005). Beyond the DSM Story: Ethical quandaries, challenges, and best practices. Sage: Thousand Oaks, CA.

    Google Scholar 

  • First, M. B. (2005). Mutually exclusive versus co-occurring diagnostic categories: The challenge of diagnostic comorbidity. Psychopathology, 38(4), 206–210.

    Article  Google Scholar 

  • First, M. B. (2010). Paradigm shifts and the development of the diagnostic and statistical manual of mental disorders: Past experiences and future aspirations. The Canadian Journal of Psychiatry, 55, 692–700.

    Google Scholar 

  • Gambrill, E. (2005). Critical thinking, evidence-based practice, and mental health. In S. A. Kirk (Ed.), Mental disorders in the social environment: Critical perspectives (pp. 247–269). New York: Columbia University Press.

    Google Scholar 

  • Garland, E. L., & Howard, M. O. (2009). Neuroplasticity, psychosocial genomics, and the biopsychosocial paradigm in the 21st century. Health and Social Work, 34(3), 191–199.

    Article  Google Scholar 

  • Groopman, J. (2007). How doctors think. New York: Houghton Mifflin.

    Google Scholar 

  • Haslam, N. (2000). Psychiatric categories as natural kinds: Essentialist thinking about mental disorder. Social Research, 67, 1031–1058.

    Google Scholar 

  • Henry, S. G. (2006). Recognizing tacit knowledge in medical epistemology. Theoretical Medicine and Bioethics, 27, 187–213.

    Article  Google Scholar 

  • Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., et al. (2010). Research domain criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167, 748–751.

    Article  Google Scholar 

  • Jablensky, A. (2005). Categories, dimensions, and prototypes: Critical issues for psychiatric classification. Psychopathology, 38(4), 201–205.

    Article  Google Scholar 

  • Jacobs, D. H. (2014). Mental disorder or “normal life variation?” Why it matters. Research on Social Work Practice, 24, 152–157.

    Article  Google Scholar 

  • Kirmayer, L. J. (2005). Culture, context and experience in psychiatric diagnosis. Psychopathology, 38, 192–196.

    Article  Google Scholar 

  • Ledgerwood, A., & Chaiken, S. (2007). Priming us and them: Automatic assimilation and contrast in group attitudes. Journal of Personality and Social Psychology, 93(6), 940–956.

    Article  Google Scholar 

  • Link, B. G., Cullen, F. T., Struening, E. L., & Strout, P. E. (1989). A modified labeling theory approach to mental disorders: An empirical assessment. American Sociological Review, 54(3), 400–423.

    Article  Google Scholar 

  • Markova, I. S., & Berrios, G. E. (2009). Epistemology of mental symptoms. Psychopathology, 42, 343–349.

    Article  Google Scholar 

  • McQuaide, S. (1999). A social worker’s use of the diagnostic and statistical manual. Families in Society, 80(4), 410–417.

    Google Scholar 

  • McWilliams, N. (2011). The psychodynamic diagnostic manual: An effort to compensate for the limitations of descriptive psychiatric diagnosis. Journal of Personality Assessment, 93, 112–122.

    Article  Google Scholar 

  • Mezzich, J. E., & Berganza, C. E. (2005). Purposes and models of diagnostic systems. Psychopathology, 38(4), 162–165.

    Article  Google Scholar 

  • Milich, R., McAninch, C. B., & Harris, M. J. (1992). Effects of stigmatizing information on children’s peer relations: Believing is seeing. School Psychology Review, 21(3), 400–409.

    Google Scholar 

  • Moss, S. E., & Lawrence, K. G. (1997). The effects of priming on the self-reporting of perceived stressors and strains. Journal of Organizational Behavior, 18, 393–403.

    Article  Google Scholar 

  • Overholser, J. C. (2014). Chasing the latest fad: Confronting recent and historical innovations in mental illness. Journal of Contemporary Psychotherapy, 44(1), 53–61.

    Article  Google Scholar 

  • Paris, J. (2013). The intelligent clinician’s guide to the DSM-5. Oxford: New York.

    Google Scholar 

  • Phillips, J. (2005). Idiographic formulations, symbols, narratives, context, and meaning. Psychopathology, 38(4), 180–184.

    Article  Google Scholar 

  • Probst, B. (2012). Diagnosing, diagnoses, and the DSM in clinical social work. Families in Society, 93(4), 255–263.

    Google Scholar 

  • Probst, B. (2013). “Walking the tightrope:” Clinical social workers’ use of diagnostic and environmental perspectives. Clinical Social Work Journal, 41(2), 184–191.

    Google Scholar 

  • Ravotas, D., & Berkenkotter, C. (1998). Voices in the text: the uses of reported speech in a psychotherapist’s notes and initial assessment. Text, 18(2), 211–239.

    Google Scholar 

  • Saleebey, D. (2001). Nature and nurture, neurons and narratives: Putting it all together (Chap. 5). In D. Saleebey (Ed.), Human behavior and social environments: A biopsychosocial approach. New York: Columbia University Press.

    Google Scholar 

  • Scheff, T. A. (1966). Being mentally Ill: A sociological theory. Chicago: Aldine.

    Google Scholar 

  • Temerlin, M. K. (1968). Suggestion effects of psychiatric diagnosis. Journal of Nervous and Mental Disease, 147(4), 349–353.

    Article  Google Scholar 

  • Thyer, B. A. (2006). It is time to rename the DSM. Ethical Human Psychiatry and Psychology, 1, 61–67.

    Article  Google Scholar 

  • Thyer, B. A. (2014). Review of Alan Francis’ essentials of psychiatric diagnosis: Responding to the challenge of DSM-5. In Research on Social Work Practice, 24(1), 164–168.

    Google Scholar 

  • Tversky, A., & Kahneman, D. (1973). Availability: A heuristic for judging frequency and probability. Cognitive Psychology, 5, 207–232.

    Article  Google Scholar 

  • Wakefield, J. C. (2005). Disorders versus problems of living in DSM: Rethinking social work’s relationship to psychiatry. In S. A. Kirk (Ed.), Mental disorders in the social environment: Critical perspectives (pp. 83–95). New York: Columbia University Press.

    Google Scholar 

  • Wakefield, J. C. (2007). The concept of mental disorder: Diagnostic implications of the harmful dysfunction analysis. World Psychiatry, 6, 149–156.

    Google Scholar 

  • Watters, E. (2010). Crazy like us: The globalization of the American psyche. Free Press: New York.

    Google Scholar 

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Correspondence to Barbara Probst .

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Probst, B. (2015). Epistemological Issues in Diagnosis and Assessment. In: Probst, B. (eds) Critical Thinking in Clinical Assessment and Diagnosis. Essential Clinical Social Work Series. Springer, Cham. https://doi.org/10.1007/978-3-319-17774-8_2

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