How the Diagnostic & Statistical Manual (DSM) Came to Be

Michael is a neatnick. This is not bad. He keeps everything in order, can find whatever he needs, feels free of debris, and thinks more clearly because of it. His wife, Marcie, is a bit more, shall we say, free. She is not bound by rules of where to put things, how to think, or when to do what. This may not be bad, either. She is an artist and has exhibited at major galleries across the nation. She does have a bit of challenge getting supper for the kids on time so Michael and Marcie have worked out that they would prepare it the night before and have it ready to pop into the oven the next day. Frequently, he will leave a piece of paper on the pan of food in the fridge saying something like, “put in oven at 5:30.” Michael finds his wife’s messiness a bit challenging but he fell in love with her free spirit, something that was not present in the house in which he grew up. He is proud of her national acclaim. And he doesn’t mind the income it brings in either. Marcie is delighted to have a husband that appreciates her creativity and who keeps some order in their lives. She grew up with one overburdened parent in the house and an absent one. She cannot remember family meals, so she was drawn to someone who represented stability and home. This is a healthy couple. They enjoy each other’s uniqueness. What’s bad about diagnostic labeling in your marriage Not every couple who is attracted to their opposite continues to appreciate...

Psychiatric Evaluation

Mental illness and criminality are evaluated by different sorts of professionals doing very different things. Here are some of the points of distinction: Mental Health Evaluation In the State of Florida, all the five major classes of psychotherapist—Marriage and Family Therapist, Social Worker, Mental Health Counselor, Psychologist, and Psychiatrist—are required to know how to give “ordinary” mental health evaluations. Such an evaluation is used to create a diagnosis of the person coming in for treatment. The diagnosis, in turn, is used to bill insurance companies, or to determine if a person needs admission to a hospital. The diagnosis is selected from a book called The Diagnostic and Statistical Manual of Mental Disorders written by a large committee of the American Psychiatric Association. There have been several overhauls over the past half-century. Of interest, is the fact that in Europe, there are not so many categories as here, and of even greater interest is that there can be large disagreements among professionals in deciding the diagnosis. That lack of reliability notwithstanding, any time your therapist bills a third party, this diagnosis is required. Theoretically, the diagnosis should guide treatment much the same way as a medical diagnosis determines whether a person needs an antibiotic (for a bacterial infection) or not (for a viral infection). In actual practice, statistically, the diagnosis has very little bearing on the treatment of emotional issues. One reason, as I just said, is that different clinicians observing a person, reading the history in the file, asking good questions, and checking with family will still come up with a variety of different diagnoses; diagnosing is more an...
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