Lesson Two – Evaluation of the Four Ds of diagnosis Clinical Psychology Lesson Two – Evaluation of the Four Ds of diagnosis

Davis (2009) Feedback from homework task – reading and making notes

Defining abnormality – problems? “abnormality” is a social construction that has evolved over time without regulating definitions Cultural differences? Within the culture of one ethnic group it may be seen as normal to “see or hear” the deceased relative during the bereavement period However in another culture this could be misdiagnosed as a symptom of a psychotic disorder.

Reliability and validity when it comes to diagnosis Is the diagnosis reliable? Reliability of diagnosis: Will different diagnosticians using the same classification system arrive at the same diagnosis? What should happen if three different practitioners interview the client and they all use the 4 ds? Is the diagnosis valid? Validity of diagnosis: Does the person diagnosed have real symptoms with a real underlying cause? (the illness is not socially constructed, the person is not faking) Diagnoses may be consistent but what if they are wrong? What if the conclusions are wrong?

Thoman Szasz “ The Myth of Mental Illness” (1962) Mental disorders should be considered to be “problems of living” Szasz is against the idea of pathology in psychiatric disorders Szasz does not believe the abnormal behaviour is not a symptom of an underlying brain disease Frude (1998) few psychological disorders are associated with identifiable organic pathology Neuropsychologists have revealed chemical abnormality in the brain in people suffering with schizophrenia Is Szasz’s argument still valid today?

Should Martin (the patient) be referred for clinical diagnosis? Deviance? Martin is a 21 year-old business major at a large university. Over the past few months his family and friends have noticed increasingly bizarre behaviours. On many occasions they’ve overheard him whispering in an agitated voice, even though there is no one nearby. Lately, he has refused to answer or make calls on his cell phone, claiming that if he does it will activate a deadly chip that was implanted in his brain by evil aliens. He has accused his family on several occasions of conspiring with the aliens to have him killed so they can remove his brain and put it inside one of their own. Martin frequently breaks down in tears when he confronts his family of conspiring with the aliens to have him killed. He doesn’t understand why they want to hurt him. He has stopped attended classes altogether. He is now so far behind in his coursework that he will fail if something doesn’t change very soon. Dysfunction? Danger Distress Duration?

Are there any limitations to this process? Group Two Group one You are the clinician that referred Martin to have a clinical diagnosis. Explain why you did this. What are the strengths of the 4 ds of diagnosis process? Research – resources on the learning space You are reading about Martin’s case and you decide to argue the previous decision. Are there any limitations to this process? Can you refer to reliability and validity? Issues/Debates? Research – resources on the learning space Subjectivity – interpretation Differen social norms in different countries – cultue of patient needs to be taken into account Seen differently by different people reliability Measured in a standardised way? Deviation – based on standard measure Standardised tests available and used – not use personal judgements

In pairs Person from group one – provide your argument to the person from group 2 Person from group two – provide your argument to the person from group 1 Discuss these arguments Ensure you understand their points and have made notes Person from group one will have to argue the limitations Person from group two will have to argue the strengths

Objectivity vs Subjectivity Four Ds of diagnosis Culture Objectivity vs Subjectivity Reliability Validity Socially sensitive – labelling good to label or not? Development over time – addition to ds Issues and debates? Strength or weakness? Why?

Table to complete – Evaluation of the four ds Strengths limitations

Discuss the difficulties of using the 4ds to define abnormality (8 marks) How do we answer this? Structure?

H/W 20-30 minutes of research on the DSM Specifically DSM 5 but you can also look at previous versions to familiarise yourself with the changes Bring some notes into the lesson so we can discuss the DSM