Values And Psychiatric Diagnosis

In this work, John Z. Sadler examines the nature and significance for practice of the value-content of psychiatric diagnostic classification.

With a new edition of the 'bibles' of psychiatric diagnosis - the ICD and DSM - under development, it is timely to take a step back and evaluate how we diagnose and define mental disorder. This new book by Derek Bolton tackles the problems involved in the definition and boundaries of mental disorder.

This book provides an overview of the strengths and limitations of the currently available systems for the diagnosis and classification of mental disorders, in particular the DSM-IV and the ICD-10, and of the prospects for future developments. Among the covered issues are: * The impact of biological research * The diagnosis of mental disorders in primary care * The usefulness and limitations of the concept of comorbidity in psychiatry * The role of understanding and empathy in the diagnostic process * The ethical, legal and social aspects of psychiatric classification Psychiatric Diagnosis & Classification provides a comprehensive picture of the current state of available diagnostic and classificatory systems in psychiatry and the improvements that are needed.

Most everyone agrees that having pneumonia or a broken leg is always a bad thing, but not everyone agrees that sadness, grief, anxiety, or even hallucinations are always bad things. This fundamental disjunction in how disease and disorders are valued is the basis for the considerations in Descriptions and Prescriptions. In this book John Z. Sadler, M.D., brings together a distinguished group of contributors to examine how psychiatric diagnostic classifications are influenced by the values held by mental health professionals and the society in which they practice. The aim of the book, according to Sadler, is "to involve psychiatrists, psychologists, philosophers, and scholars in related fields in an intimate exchange about the role of values in shaping past and future classifications of mental disorders." Contributors: George J. Agich, Ph.D., Cleveland Clinic Foundation; Carol Berkenkotter, Ph.D., Michigan Technological University; Lee Anna Clark, Ph.D., University of Iowa; K.W.M. Fulford, D.Phil., F.R.C.Psych., University of Warwick, Coventry; Irving I. Gottesman, Ph.D., University of Virginia; Laura Lee Hall, Ph.D.; Cathy Leaker, Ph.D., Empire State College; Chris Mace, M.D., M.R.C.Psych., University of Warwick, Coventry; Laurie McQueen, M.S.S.W., American Psychiatric Association, Washington, D.C.; Christian Perring, Ph.D., Dowling College; James Phillips, M.D., Yale University School of Medicine; Harold Alan Pincus, M.D., University of Pittsburgh School of Medicine; Jennifer H. Radden, D.Phil., University of Massachusetts; Doris J. Ravotas, M.A., L.L.P., Michigan Technological University; Patricia A. Ross, Ph.D., University of Minnesota; Kenneth F. Schaffner, M.D., Ph.D., George Washington University; Michael Alan Schwartz, M.D., Case Western Reserve University; Daniel W. Shuman, J.D., Southern Methodist University; Allyson Skene, Ph.D., York University; Jerome C. Wakefield, D.S.W., Rutgers University; Thomas A. Widiger, Ph.D., University of Kentucky; Osborne P. Wiggins, Ph.D., University of Louisville.

Many published books that comment on the medical model have been written by doctors, who assume that readers have the same knowledge of medicine, or by those who have attempted to discredit and attack the medical practice. Both types of book have tended to present diagnostic categories in medicine as universally scientifically valid examples of clear-cut diseases easily distinguished from each other and from health; with a fixed prognosis; and with a well-understood aetiology leading to disease-reversing treatments. These are contrasted with psychiatric diagnoses and treatments, which are described as unclear and inadequate in comparison. The Medical Model in Mental Health: An Explanation and Evaluation explores the overlap between the usefulness of diagnostic constructs (which enable prognosis and treatment decisions) and the therapeutic effectiveness of psychiatry compared with general medicine. The book explains the medical model and how it applies in mental health, assuming little knowledge or experience of medicine, and defends psychiatry as a medical practice.

This open access book offers essential information on values-based practice (VBP): the clinical skills involved, teamwork and person-centered care, links between values and evidence, and the importance of partnerships in shared decision-making. Different cultures have different values; for example, partnership in decision-making looks very different, from the highly individualized perspective of European and North American cultures to the collective and family-oriented perspectives common in South East Asia. In turn, African cultures offer yet another perspective, one that falls between these two extremes (called batho pele). The book will benefit everyone concerned with the practical challenges of delivering mental health services. Accordingly, all contributions are developed on the basis of case vignettes, and cover a range of situations in which values underlie tensions or uncertainties regarding how to proceed in clinical practice. Examples include the patient’s autonomy and best interest, the physician’s commitment to establishing high standards of clinical governance, clinical versus community best interest, institutional versus clinical interests, patients insisting on medically unsound but legal treatments etc. Thus far, VBP publications have mainly dealt with clinical scenarios involving individual values (of clinicians and patients). Our objective with this book is to develop a model of VBP that is culturally much broader in scope. As such, it offers a vital resource for mental health stakeholders in an increasingly inter-connected world. It also offers opportunities for cross-learning in values-based practice between cultures with very different clinical care traditions.

Psychiatric and psychological practice and research is critically dependent on diagnosis. Yet the nature of psychiatric diagnosis and the rules by which disorders should be created and organized have been highly controversial for over 100 years. Unlike simple medical disorders (like infectious diseases), psychiatric disorders cannot be traced to one simple etiologic agent. The last two generations have seen major conceptual shifts in the approach to diagnosis with the rise of operationalized criteria and an emphasis on a descriptive rather than etiological approach to diagnosis. The interest in psychiatric diagnoses is particularly heightened now because both of the major psychiatric classifications in the world - DSM and ICD - are now undergoing major revisions. What makes psychiatric nosology so interesting is that it sits at the intersection of philosophy, empirical psychiatric/psychological research, measurement theory, historical tradition and policy. This makes the field fertile for a conceptual analysis. This book brings together established experts in the wide range of disciplines that have an interest in psychiatric nosology. The contributors include philosophers, psychologists, psychiatrists, historians and representatives of the efforts of DSM-III, DSM-IV and DSM-V. Some of the questions addressed include i) what is the nature of psychiatric illness? Can it be clearly defined and if so how? ii) What is the impact of facts versus values in psychiatric classification? iii) How have concepts of psychiatric diagnosis changed over time? iv) How can we best conceptualize the central idea of diagnostic validity? And v) Can psychiatric classification be a cumulative enterprise seeking improvements at each iteration of the diagnostic manual? Each individual chapter is introduced by the editors and is followed by a commentary, resulting in a dynamic discussion about the nature of psychiatric disorders. This book will be valuable for psychiatrists, psychologists and other mental health trainees and professionals with an interest in the questions and problems of psychiatric diagnosis, as well as philosophers and philosophy students interested in the problems posed by psychiatry, particularly those working in the philosophy of science.

This book critically evaluates the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Through analysis of the history of psychiatric diagnosis and of the handbook itself, it argues that the DSM-5 has a narrow biomedical approach to mental disorders, and proposes a new contextualizing model of mental health symptoms.