Читать книгу Understanding Mental Health and Counselling - Группа авторов - Страница 62

Psychiatric diagnosis involves the application of a medical framework to problems in living. By comparing people’s reported problems against the criteria found in diagnostic manuals such as the DSM, the closest-matching diagnostic category or categories can be identified. This chapter has explored whether a medical framework can appropriately be applied to mental health. It has also examined the process of medicalisation, by which problems in living can come to be viewed as mental illnesses. In the case of PTSD, the medicalisation of the condition was welcomed by activists for Vietnam veterans, whereas gay and lesbian activists campaigned to de-medicalise homosexuality and feminists have criticised the inclusion of PMDD in the DSM.

The content of the DSM has changed over the sixty years between its first and fifth editions. It has changed from being a brief list of categories designed to produce statistics on the characteristics of adult patients in asylums to a larger, more detailed manual with a much broader scope. The DSM now covers the entire lifespan – including problems of varying severity – across a broader range of settings and serves a wider range of functions.

This chapter has identified shifts in the theoretical models that have informed the DSM – from the broadly organic and psychodynamic approach of the first two editions, through to the more biomedical approach of the third edition. Finally, it looked at the fifth edition’s departure from Spitzer’s principles, with its focus on clinical rather than research utility and the conflict between the DSM-5 and RDoC projects. This chapter has also examined a number of the conceptual, ethical and practical problems of psychiatric diagnosis, including its reliability, validity and the appropriateness of a medical framework. Whatever your views about diagnosis, it seems likely that it will continue to have a significant influence on mental health for some time to come.