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Psychiatry and Diagnosis

Psychiatrists are medical doctors, and the model for assessing psychological problems in psychiatry is the medical model. In describing this model, Kandel (1998) argues that all mental processes can be traced to brain function, that essentially mind is a function of brain (also see Ray, 2004). This leads to the idea: change the brain, change the mind. However, the alternative idea – change the mind, change the brain – also works (cf. Plassman, 2008; Carlat, 2010; Zubieta, et al, 2001). In general psychotropic medications can be very helpful, though they rarely eliminate a psychological problem. Therapy in addition to medication is an excellent approach for addressing problems.

The American Psychiatric Association publishes the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000; hereafter DSM-5), which is the standard diagnostic tool of the medical model of mental disorders. Constructivism stands as a major alternative to the medical model as a way of looking at or understanding psychological problems. While it may be appropriate to say that a client exhibits behaviors consistent with a particular diagnosis, clients should never be told that they “have” a disorder. Diagnostic labels should be understood more as broad categories of behaviors covered by insurance than as conditions.

Dr. Mau is not a physician, he does not provide medical advice, and he generally operates from a Constructivist rather than a medical model perspective. He does work in a team approach with physicians and psychiatrists to address client problems. Clients should follow the medical instructions of their physician or psychiatrist. It can be dangerous to simply stop taking certain medications, and you should never stop taking medication without consulting your physician.

Dr. Mau is qualified to provide DSM-5 diagnoses, and will do so when this is necessary for insurance reimbursement. A DSM-5 diagnosis should be understood as a shorthand label for particular behaviors occurring presently and not as a condition of a person. Think about it: “behavior” can be changed – even if it is driven by emotion and seems involuntary, while “conditions” seem difficult to change.

The Social Construction of Psychopathology

Quote from Maddux, Gosselin, and Winstead (2008, p. 14):

The social construction of psychopathology works something like this. Someone observes a pattern of behaving, thinking, feeling, or desiring that deviates from some social norm or ideal or identifies a human weakness or imperfection that, as expected, is displayed with greater frequency or severity by some people that others. A group with influence and power decides that control, prevention, or treatment of this problem is desirable or profitable. The pattern is then given a scientific-sounding name, preferably of Greek or Latin origin. The new scientific name is capitalized. Eventually the term may be reduced to an acronym, such as OCD (Obsessive-Compulsive Disorder), ADHD (Attention-Deficit/Hyperactivity Disorder), and BDD (Body Dysmorphic Disorder). The new disorder then takes on an existence all its own and becomes a disease-like entity. As news about “it” spreads, people begin thinking they have “it;” medical and mental health professionals begin diagnosing and treating “it;” and clinicians and clients begin demanding that health insurance policies cover the “treatment” of “it.” Once the “disorder” has been socially constructed and defined , the methods of science can be used to study it, but the construction itself is a social process, not a scientific one. In fact, the more “it” is studied, the more everyone becomes convinced that “it” is really “something.”