Assignment: Mental Health versus Mental Illness

Assignment: Mental Health versus Mental IllnessAssignment: Mental Health versus Mental IllnessORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS Patterns of mental illness might be concealed all too well by external variables, such as a successful lifestyle, a well-groomed appearance, or a dynamic personality. At times, those suffering with mental illness may be able to control external variables, thus hiding any signs and symptoms. As a result, the differentiation between mental health and mental illness is not always so clear. As a future professional in the field of psychology, you must consider how mental health differs from mental illness for an accurate diagnosis on the basis of the DSM. Assignment: Mental Health versus Mental IllnessFor this discussion, consider the different ways to conceptualize mental health and mental illness in the field of psychology. Think about how this conceptualization may influence your assessment and diagnosis of a client.With these thoughts in mind:Post a brief explanation of the different ways in which mental health and mental illness may be conceptualized in the field of psychology. Then explain at least two ways in which this conceptualization may influence your assessment and diagnosis of a client. Provide examples based on current literature.2-3 Paragraphs. APA Format. In-text Citations to Support Writing. 4 attachmentsSlide 1 of 4attachment_1attachment_1attachment_2attachment_2attachment_3attachment_3attachment_4attachment_4Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 4 What Is (and Is Not) a Mental Disorder One of the problems in DSM-5 is that it extends the concept of mental disorder and can be used to diagnose those who have only subclinical symptoms or problems. This is a danger because it could lead to the creation of new categories as well as broader definitions of existing ones. We need to decide what we mean by “mental disorder” and to differentiate it from life’s vicissitudes—what Freud (1896/1957) once referred to as “normal human unhappiness.” This definition is crucial for determining the scope of psychiatry (Kagan, 2012; McNally, 2011). The ultimate question is whether DSM-5 describes a set of illnesses or problems associated with living. Disease and Disorder Medicine describes pathological states with terms such as disease or illness. Disease refers to physical abnormalities (e.g., anatomical lesions and physiological or biochemical changes) that cause discomfort or dysfunction. Illness is often used as a synonym for disease, but it may also be used to describe the subjective feeling of “being ill” (Eisenberg, 1977). In psychiatry, the use of the term mental disorder reflects a problem in defining true diseases of the mind. A disease process is based on a known and specific etiology and pathogenesis. But there are no consistent biological markers in psychiatry reflecting the pathological mechanisms behind illness. This was so 40 years ago (Kendell, 54 EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 4 W ha t I s ( a nd I s N ot) a M e n t a l D i so rd e r | 5 5 1975) and remains so today (Paris, 2008a). Thus, clinicians have to rely on signs and symptoms that cause distress or disability. That is why we use the term “disorder,” but psychiatrists may forget that disorder is not disease. Finally, although the use of the term “mental disorder” is less potentially stigmatic than “mental illness,” a few clinicians and patients still avoid it in favor of misleading and vague concepts such as “mental health condition.” But whatever you call them, mental disorders are frightening and threatening to personal autonomy. For this reason, stigma can be reduced but not eliminated. Defining Mental Disorder DSM-5 offers a complex definition of mental disorder. Patients must have a behavioral or psychological syndrome or pattern that reflects an underlying psychobiological dysfunction, the consequences of which are clinically significant distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) that must not be merely an expectable response to common stressors and losses (e.g., the loss of a loved one), a culturally sanctioned response to a particular event (e.g., trance states in religious rituals), or a result of social deviance or conflicts with society. A disorder should have diagnostic validity based on a set of external validators (prognostic significance, psychobiological disruption, or response to treatment), and it should also have clinical utility (contributing to better conceptualization or to better assessment and treatment). Finally, diagnostic validators and clinical utility should help differentiate the disorder from its “near neighbors.” Assignment: Mental Health versus Mental IllnessAs in all editions since DSM-III, the definition of mental disorder includes a set of caveats. Thus, symptoms must not appear as a part of normal development or reflect cultural variations alone. They must not be developmental quirks (e.g., the moodiness of normal adolescents) or cultural patterns (e.g., the possession states cultivated by some religions). EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 56 | Part I Diagn ostic P ri n cip l e s Each category in the manual needs to meet this overall definition. But because pathology and normality can sometimes lie on a spectrum, it is often unclear whether symptoms meet these overall criteria. That is a reason why psychiatry needs to be conservative about decisions to change criteria for any disorder or to add or delete any category. Given that even minor changes in wording can vastly increase the prevalence of a diagnosis, a risk–benefit analysis needs to be applied to assess the impact of any changes from DSM-IV to DSM-5. We should be sure that benefits follow from changes. Yet over the years, the DSM system has been more notable for adding than for subtracting, even when additions carry an unknown risk. The Theoretical Agenda of DSM-5 Traditionally, medicine has defined disease in a way that separates pathology from normality. We all have illnesses from time to time but otherwise consider ourselves as normal. Psychiatry took the same view for most of its history, and it remains reasonable to separate disease-like disorders such as schizophrenia, bipolar disorder, and melancholic depression from reaction patterns such as mild depression or anxiety disorders. The neo-Kraepelinian model of mental disorder was in accord with these principles. But practitioners wanted a system that covers all conditions they are asked to treat, and some clinicians see people who are more unhappy than ill. This is the main reason for the overinclusiveness of the DSM system. Psychiatry is not alone in this regard. Medical theory and practice has been gradually expanding its scope, “medicalizing” subclinical symptoms as well as life’s ups and downs. For example, people can go to doctors to adjust their cholesterol level, in the absence of any symptoms of disease. It has been suggested that this trend suits pharmaceutical companies, which engage in “disease-mongering” to increase profits (Moynihan et al., 2002). DSM-5 sought to overturn the neo-Kraepelinian model and replace it with one in which illness is not separate from normality EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 4 W ha t I s ( a nd I s N ot) a M e n t a l D i so rd e r | 5 7 but, rather, defined by a cutoff point on a continuum. Kupfer and Regier (2011) claimed that diagnostic spectra are supported by neuroscience research. Assignment: Mental Health versus Mental IllnessThat implies that even if people feel normal, everyone may have a bit of illness. It has long been known that mental disorders lack a sharp separation from normal functioning—or from each other (Kendell, 1975). But if you identify mental disorder in everyone, the concept loses meaning, and the scope of psychiatry becomes broad to the point of absurdity. The Boundary Between Illness and Life An old witticism states that life is a disease for which psychiatry is the cure. Behind the joke lies a reality: It is not obvious what distinguishes mental disorder from unhappiness. Psychiatry must distinguish between sadness and depression, between moodiness and bipolarity, and between eccentricity and psychosis. That is what has traditionally defined the very concept of psychopathology. The DSM manuals suffer from what military historians call mission creep—the gradual but inevitable expansion of a mission beyond its original goals. The distinction between severe mental disorders and milder disorders that reflect distress in the face of circumstance has often been ignored (Horwitz, 2002). Many categories are included that do not meet overall criteria for a mental disorder in that they present symptoms that produce distress but are reactive to circumstance. But DSM has been written to include every sort of problem, whether or not it constitutes a disorder. This problem undermines the validity of the system. Because no one can say what is or is not a mental disorder, all editions of DSM have suffered from overinclusiveness. Moreover, “medicalization” reformulates the human condition as a set of illnesses—that is, problems that lie beyond one’s personal control (Conrad, 2007). Medicalization often comes not from physicians but, rather, from patient groups seeking to destigmatize problems. Thus, Alcoholics Anonymous promoted a medical model of problem drinking long before physicians accepted it. Similarly, consumer EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 58 | Part I Diagn ostic P ri n cip l e s groups have actively promoted diagnoses such as attention-deficit hyperactivity disorder (ADHD) and posttraumatic stress disorder. Almost everything that creates trouble in human life can be found in the DSM manuals. Badly misbehaving children can be diagnosed with conduct disorder (Wakefield et al., 2002). Adults who are painfully shy can be diagnosed with a social anxiety disorder (Horwitz & Wakefield, 2012). Low mood after losses may justify a diagnosis of depression (Horwitz & Wakefield, 2007). Recurrent episodes of rage can be diagnosed as intermittent explosive disorder. It does not matter how common the problem is—even tobacco addiction is listed as a mental disorder. Given this level of inclusiveness, it should be not surprising that epidemiological studies, such as the National Comorbidity Survey (NCS-R), that examine the community prevalence of DSM-defined disorders have found mental disorders to be very common. Approximately 20% of the population will meet criteria for at least one disorder in any given year, and at least half will do so in a lifetime (Kessler et al., 2005a). Assignment: Mental Health versus Mental IllnessSome have argued that these numbers are still too low. Reporting on a prospective community study of a sample followed from childhood to age 32 years, Moffitt et al. (2009) found that prevalence of disorders measured at the time they actually appear was nearly double than what people remembered and reported in retrospective studies. Evidently, mental disorder is ubiquitous. If the lifetime prevalence of physical illness is 100%, perhaps a 50% rate for mental disorders is an encouragingly low number. However, there are other explanations for these epidemiological findings. When prevalence is very high, you have to ask whether measurements are accurate. All these numbers assume the validity of the categories listed in the DSM manual. That is a very big assumption. In the first large-scale survey, the Epidemiological Catchment Area Study (Robins & Regier, 1991), the estimates were much more cautious. Since then, diagnostic inflation, based on expansion of many DSM categories, led to much higher prevalence. It is also possible that psychiatric epidemiology made a fundamental error by agreeing to measure DSM categories rather than the symptoms on which they are based. EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 4 W ha t I s ( a nd I s N ot) a M e n t a l D i so rd e r | 5 9 One also needs to be sure that a disorder is disabling. This principle led DSM-IV to require all diagnoses to be based on symptoms that are clinically significant. The problem is that this concept requires a serious judgment call. In major depression, Wakefield et al. (2010) noted that because symptoms already measure subjective distress, adding such a requirement does not distinguish cases from non-cases. The real question concerns severity. What is the cutoff point at which distress and disability qualify as mental illness? Many problems that merit a diagnosis under the current system are painful but not disabling. For example, mass screening methods for depression are more likely to uncover transient episodes than clinical conditions that could benefit from treatment (Patten, 2008; Thombs et al., 2008). Thus, even if most people who meet criteria for psychiatric diagnoses are never treated (Kessler et al., 2005b), that need not be a matter of great concern—as long as the sickest patients find a pathway to care. Psychiatry is a branch of medicine, but one does not expect the majority of the population to have either clinical or subclinical disorders of the heart, kidney, or liver. This is what makes the findings of epidemiological research based on DSM categories hard to swallow. Some might say that a lifetime prevalence of 50% reflects a reality we just have to accept. The leaders of the National Comorbidity Study, a large-scale epidemiological survey based on DSM-IV (Kessler et al., 2003), took the view that psychiatry, like the rest of medicine, must make room for mild and subclinical disorders in its classification system. Much as general physicians treat common colds as well as pneumonia, mental health clinicians need not actively discourage people with less severe problems from coming for help. Kessler et al. also argued that mild disorders could be precursors of more severe disorders at some later point—in which case, early treatment might be preventive. However, they did not provide data on how often that actually happens or whether prevention is a practical option. Admitting subclinical phenomena into a diagnostic classification is a very slippery slope. The lifetime prevalence of mental disorders could easily come to approach 100%. Assignment: Mental Health versus Mental IllnessThe boundary between EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 60 | Part I Diagn ostic P ri n cip l e s normality and pathology would then be completely lost. Unless disorders are defined in a way that requires severe dysfunction, almost every bump on the road of life will be considered pathological. These problems also follow from the view that psychopathology of all kinds is dimensional and lies on a spectrum with normality (Pierre, 2010). Everyone has a mental disorder, the only question being how severe. This paradigm threatens to trivialize psychiatry. To be taken seriously, the specialty has to define disorder in a way that recognizes a difference between problems of living and mental illness. Harmful Dysfunction Jerome Wakefield, a professor of social work at New York University, is a seminal figure in the debate about the boundaries between normality and pathology. He has proposed defining mental disorder in terms of a construct he calls harmful dysfunction (Wakefield, 1992). These are two words, each of which requires a precise definition. For Wakefield, dysfunction refers to an inability to carry out life tasks specified by evolutionary mechanisms. Thus, conditions such as psychosis, melancholic depression, or severe substance abuse prevent people from looking after themselves or from living in families and raising children. In severe mental illness, dysfunction is obvious because it leads to striking disability. The problem lies with boundary cases. At what point is reduced function considered dysfunction? The word “harmful” adds a component of values. It means that symptoms hurt those who suffer them and/or other people with whom they are involved. But nearly every symptom patients experience is harmful in some way. The usefulness of Wakefield’s definition is that to define disorder, both harm and dysfunction are required. Thus, behavior that is only harmful (e.g., laziness and rudeness) would not justify a medical diagnosis. Nor would behavior that is only dysfunctional (e.g., drunkenness). A hybrid definition, combining harm and EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted under U.S. or applicable copyright law. 4 W ha t I s ( a nd I s N ot) a M e n t a l D i so rd e r | 6 1 dysfunction, aims to cut this Gordian knot. Even so, determining whether each of these criteria is present requires judgment calls that may not be strictly objective, and there is also an overlap between harm and dysfunction. Assignment: Mental Health versus Mental IllnessThe definition of mental disorder in DSM-5 is not very different from the concept of harmful dysfunction, but the devil lies in the details. The Scope of DSM Mission creep has steadily expanded the boundaries of mental illness. If a survey examining the presence of mental disorder identifies people who consider themselves normal but who actually meet criteria for a diagnosis, that constitutes a false negative. But if the same survey identifies people as having a disorder when criteria are not met, that constitutes a false positive. The concept of mental disorder used by the DSM system is most likely to lead to false positives. This problem bedevils DSM-5. It has no way to separate clinical from subclinical phenomena. And it is up to the clinician to decide what is “significant.” In the absence of a precise definition, the concept of “clinical significance” can only be imprecise. Since the third edition, DSM has included an increasingly long list of diagnoses. Every edition since has grown larger in scope, and the size of the manual has also grown. Again, it seems that mission creep rules. Observing this trend, Zorumski (2009, p. xxvi) commented wryly, “One might conclude that either the field has advanced greatly or we have now generated a system that codifies many poorly studied and poorly validated descriptors.” Robert Spitzer once told me he wrote DSM-III with the aim of being “inclusive”—he thought it best to include more categories and sort out their validity later. That was a mistake. What Spitzer did not take into account is that once a category is listed in the manual, it is very difficult to remove. Too many people have a stake in maintaining it. When it came time to publish DSM-IV, only a few diagnoses were taken out, while quite a few others were added. EBSCO : eBook Collection (EBSCOhost) – printed on 5/30/2018 10:08 AM via WALDEN UNIV AN: 939818 ; Paris, Joel.; The Intelligent Clinician’s Guide to the DSM-5? Account: s6527200.main.ehost Copyright @ 2015. Oxford University Press. All rights reserved. May not be reproduced in any form without permission from the publisher, except fair uses permitted… Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10 Order NowjQuery(document).ready(function($) { $.post(‘https://nursingpaperessays.com/wp-admin/admin-ajax.php’, {action: ‘wpt_view_count’, id: ‘61447’});});jQuery(document).ready(function($) { $.post(‘https://nursingpaperessays.com/wp-admin/admin-ajax.php’, {action: ‘mts_view_count’, id: ‘61447’});});