SOCIAL WORK AND THE DSM: C/O C REGEHR, U OF T SCHOOL OF S WORK, 2004

“The DSM has long been a lightning rod within social work…”

PROS / CONS
Can help organize observations and information about one aspect of a client’s life / Categories are just descriptions of symptoms – no information on cause/or course of disorder, or treatment planning
Provides a common language that helps communication between mental health workers / Still ethnocentric, and assumes diagnostic categories are universal, not always ready to consider cultural differences --- though this is changing in DSM 5
Categories of disorder allow for more efficient assessment / Often ignores the ‘social matrix’ in which client’s problems occur
From medical perspective, it is irresponsible to not recognize a serious mental illness and insist that client is having ‘a problem with living’ / Does not speak to problems of concern to social workers ie family problems, oppression, injustice, unemployment, homelessness
Disorders can be added, and disorders can be deleted as research grows / Can be seen as a set of political compromises among groups wishing to pathologize ‘normal’ behaviours (premenstrual dysphoric disorder?) thus allowing psychiatry to have more power than other mental health workers
Medical Model allows clients to see their ‘problem’ as an illness, similar to diabetes, and thus less stigmatizing / Uncritically accepts a disease/brain/medical model of emotional distress
Assumption of brain disorder (medical model) can lead to effective drug treatment or psychosurgery (Deep Brain Stimulation etc) / Fails to direct clients to alternative treatments ie psychotherapy, support groups
Only focuses on problems, not whole person / Ignores client strengths
Accurate diagnosis can be liberating for client who can get access to programs, and Disability Support from government / Women sometimes pathologized, labelled for ‘female’ behaviours’ or female ‘biological processes’
Poor rates of reliability
DSM 4 & 5 expands the ranges of behaviours considered ‘pathological’ie Normal Grief becomes a Depressive Disorder, Disruptive Mood Dysregulation Disorder = child’s tantrum