The Persons (1986) paper was an extremely refreshing read for me, in that it affirmed certain observations and suspicions that have profoundly impacted my motivation to study clinical psychology. Though most of the arguments Persons makes in favor of an "underlying-mechanisms" rather than "diagnostic-category" focus struck a chord with me, I'd like to reflect in particular on her criticism that "fascinating and important psychological phenomena are ignored" by the rigid "diagnostic-category" approach.
This sentiment resonates on several levels. From an empirical, observation-based perspective, I have seen it born out again and again in my 2 years of conducting structured diagnostic interviews. Among the literal hundreds of SCIDs I conducted on a diverse array of research and clinical patients over those 2 years, the most interesting and memorable interviewees were consistently those who 1) met criteria for well over half of the Axis I and II diagnoses and 2) defied the conventional clinical presentation of every single one. These were, for instance, the adult patients who had been diagnosed with Major Depression for years, but were now being referred to the Autism clinic because they presented with severe social withdrawal, "idiosyncratic" interests, and "stereotypic" behaviors that their therapist and psychiatrist had no idea what to do with (e.g. a fascination with a particular novelist or historical era, accompanied by an experience of life-long ridicule and rejection and a resulting conviction that "no one will ever understand"; an incredibly sophisticated expertise within a field like linguistics or calculus, accompanied by social isolation and the conviction that one's expertise will never have any cash value among "normal people"; an intense discomfort with unexpected changes in routine, arising not from any traditional "Autistic" tendency but from an intellectualized fear of losing control and seeing proof of one's self-perceived ineptitude at coping; etc.). Across all these cases and many others, I actually did notice certain natural "categories" and common phenomena emerging - but often these were much more descriptively and accurately captured with reference to certain etiological patterns and common mechanisms (such as "ruminative thinking style," "external locus of control," "internalizing reaction to trauma," "prefrontal functioning / executive control deficit," etc.) than with reference to DSM diagnoses.
And now I'm way over my word limit, but to quickly address the other perspective (which has a lot to do with why I'm here today): I became fascinated with psychology back in my teen years, after basking in the poignant and complex mental worlds of the patients presented in fictional and non-fictional accounts of mental illness (and, not gonna lie, of some real-world friends and acquaintances as well). Then I came to college and took my first Abnormal class - and felt all my accumulated fascination and excitement rapidly sinking to rock-bottom under the lead weight of the DSM IV classification system. So this is what psychologists' "understanding" of mental illness boils down to, I thought?? A bunch of generic checklists that could just as easily be administered by a computer, that would lump a Will Hunting and an Anna Karenina into one "diagnostic category" and make no further distinctions? What a sad anticlimax! Fortunately, with the aid of good professors and advisors and good, provocative literature (like this Persons paper) and reaffirming clinical field experiences, I've developed a hearty skepticism toward the DSM IV classification system - and regained my excitement and optimism about the field of psychology.
There's a lot more I'm tempted to say, but I've already reached the point of avoiding the "word count" button like the plague - so I'll cut myself off here, and will look forward to picking up the discussion in class tomorrow.
No comments:
Post a Comment