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Article Excerpt
Mental health counseling programs have an ethical responsibility to teach students to think about the sociopolitical context in which behaviors become understood as symptoms of mental disorders. Elaborating on this idea, the author discusses the importance of critical thinking and of adopting a reflective comportment when mental health counselors are engaged in the process of psychiatric diagnosis. Specific suggestions for helping mental health counselors in training develop critical thinking skills and apply them to psychiatric diagnosis are identified.
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The whole tired question of the correspondence between words and world stems from a simple confusion between epistemology and the history of art. We have taken science for a realist painting, imagining that it made an exact replica of the world. (Latour, 1999, p. 78) Diagnostic labels locate the causes of the problem within the individual; this may foreclose consideration of the societal context and interpersonal relations as sources of unhappiness. (Hare-Mustin & Marecek, 1997, p. 109)
What assumptions inform the theory and use of psychiatric taxonomy? Responding to this question requires professionals to take seriously Latour's keen observation, because it soon becomes apparent that one of the most basic assumptions is that it is both possible and desirable to try and provide an exact replica of the "world" of mental illness. That is, the field of psychopathology is grounded in the belief that mental disorders exist a priori; through empirical research, mental health professionals will be able to discover all disorders, identify their respective etiologies, and develop effective psychopharmacological interventions for each. In contrast to the positivist assumption that diagnoses accurately describe preexisting illnesses, this article is based on the position that diagnostic categories are constitutive; they construct, rather than represent, reality (Burr, 1995; Cosgrove, 2000; Parker, Georgaca, Harper, McLaughlin, & Stowell-Smith, 1995). That is, psychiatric labels create certain realities and marginalize others and in the process, may inadvertently sustain unjust social relations.
For example, Chesler (1972), Hollingshead and Redlich (1958), Horney (1973), and Szasz (1961) long ago addressed the oppressive implications of psychiatric labeling and the ways in which such labeling may reinforce gender, class, and race bias. In light of these criticisms, as well as the fact that the discipline of mental health counseling emphasizes the importance of contextualizing clients' problems (Brown & Srebalus, 2003; Seiler, 1996; Weikel & Palmo, 1996), it is not surprising that a number of scholars have suggested that mental health counselors (MHCs) be judicious in their use of psychiatric taxonomy. As Hershenson (1993) noted, "the most frequently stated underlying principle of MHC is that the uniqueness of the field among mental health professions lies in its focus on the promotion of normal, healthy development, rather than on the remediation of psychopathology" (p. 430). However, an ideological commitment to a preventive and developmental model does not negate the need for MHCs to develop knowledge of psychodiagnostics and psychiatric taxonomy. In fact, the Council for Accreditation of Counseling and Related Educational Programs (CACREP) standards are clear that MHCs should be trained in psychodiagnostics (CACREP, 2001; Hansen, 1998). Thus, although the identity of MHCs is not medical, their training allows them to work effectively in agencies with a strong medical model. Especially in this era of managed care, licensed MHCs are required to use the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition Text Revision ([DSM-IV-TR], APA, 2000) if they are to receive third-party reimbursement. An increasing number of MHCs are working in settings where they are routinely diagnosing clients (Fong & Sherrard, 1991; Hansen, 1998; Hohenshil, 1996; Mead, Hohenshil, & Singh, 1997). Increased familiarity and skill in using the DSM will enhance collaboration with other mental health care providers (Geroski, Rodgers, & Breen, 1997).
Hence, a critically important task is to train MHCs to use the DSM (APA, 2000) in a way that is consonant with the unique focus of the mental health counseling profession. In addition, there is a pressing need for faculty to address the issue of bias in psychiatric diagnosis, because many programs have been remiss in this area (Caplan & Cosgrove, 2004; see also Cook, Warnke, & Dupuy, 1993; Sinacore-Guinn, 1995). Although the curricula of mental health counseling programs have become increasingly rigorous and more departments are committed to preparing students to work toward social justice, the development of critical thinking remains an important area for curricula enhancement. The purpose of this article is to (a) outline some of the issues with which faculty must contend if they are to train students to use the DSM in a way that is consonant with the philosophy and focus of the mental health counseling profession, and (b) provide suggestions for MHC training programs so that MHCs will be better equipped to think critically about the sociopolitical context in which symptoms are manifest.
MOVING BEYOND CAUSAL MODELS: THE IMPORTANCE OF CRITICAL REFLECTION AND AVOIDING BIAS
In order to develop critical thinking skills and apply them to psychiatric diagnosis, it is imperative that students develop an appreciation for the epistemological commitments (i.e., claims about knowledge and truth) that ground mental health research. Many researchers start from the assumption that research hypotheses, data analyses, and diagnostic labels are neutral, objective, and free of bias. This assumption sustains the science/politics binary because it is based on the belief that science, in contrast to politics, is uncontaminated by power and particular interests (Harris, 1997). Challenging dichotomous...
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