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Snippet of The Social Work Podcast: DSM Diagnosis for Social Workers

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The Social Work Podcast
Last Played: February 05, 2021
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In this first part of a two-part lecture on diagnosis and assessment, The Social Work Podcast reviews the history of the Diagnostic and Statistical Manual of Mental Disorders. One of the most common types of assessments made by social workers, Jonathan Singer briefly dives into the history of DSM diagnoses.
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In the late 19 forties, the center of the intellectual world had shifted to New York City. Europe was financially and socially defeated from World War Two. The United States was the victor, and the concept of disease had expanded to include mental illness. And the I C D um included six mental illnesses. Now, in 1952 the first diagnostic and statistical manual of mental disorders was published, and the D. S M one included about 100 and six diagnoses. Now, when we think about cultural, intellectual and political influences, the diagnoses were heavily influenced by a man named manager who worked with vets from World War Two. And he saw most problems as emanating from biological causes, and in that sense they were reactions to specific things. For example, one of the diagnoses was reaction toe war. These diagnoses were not based on any scientific studies, and and this is through no fault of the authors of the first GSM. But without these categories in the first place, there was no classification from which to do research. So this first GSM contained a paragraph long descriptions of what reaction toe war looked like. Now note that reaction Toe war actually is an explanation for why somebody might be acting a certain way rather than a description of how they're acting. And this is important as we move along to our current diagnostic and statistical manual now, in the 19 fifties, we also saw the advent of psychotropic medications that affect people's emotional well being. One of the most famous medications was Valium, also known as Mother's Little Helper, and get treated anxiety. Thorazine was invented, used to treat psychosis, schizophrenia, and, um, in order to effectively test these drugs, the drug companies needed a way to accurately identify what it was they were treating. And the DSM one and the D. S M two both suffered from the same problem, which was they had poor integrator reliability to clinicians could see the same client and come up with different diagnoses. Good inter rater Reliability would mean that, um, to clinicians would see the same person and come up with same diagnosis. And they would do that because the criteria for meeting the diagnosis were specific enough that the determination of a diagnosis, um, would not be subjective. But I would rather be based on the criteria and the symptoms presented. So the drug companies were looking for precise diagnosis and the d S M one and the D S m two had poor inter rater reliability. Now the D S m uh, two came out in 1960 eight. The same year is the I C D seven. The biological reactions from the D. S. M one were actually replaced with psychodynamic explanations, and these influences came out of Freud and other psychodynamic theorists. So, for example, the the explanation of somebody's behavior in the d S m one might have said reaction toe war. Uh, in the d S m two, they talked a lot about neurosis. So a diagnosis diagnosis was neurosis due to underlying conflict again. Notice how the diagnosis is actually on explanation for an underlying reason for someone's problems. Now the D. S. M two did include a child section, and this was part of the societal recognition that Children could actually suffer. And there was also remember, in the 19 sixties, the late 19 sixties in particular, there was a lot of teenage and young adult rebellion, sex, drugs and rock and roll. Hippie counterculture protests. All these things that were going on. And the war generation, which Tom Brokaw called the greatest generation in general, didn't understand what was going on. Thio the these adolescents. And so they started understanding, um, these problems as mental disorders on one of the diagnoses in D s m two was, in fact adjustment toe adolescents. This was a diagnosis that everyone loved kids and adults alike. In the D. S. M two, you had neurosis and psychosis, which in the d S m four have been updated to be called anxiety and psychotic symptomology. Now the d S. M to still didn't fully address the needs of researchers because disorders were descriptors rather than classify IRS. It wasn't until 1980 that the D S M three created major changes in how diagnoses were described and defined and how they were used. So the three major changes in the D. S. M three, where that uh, it was a theoretical that is they did not give causes for people's mental illnesses. For example, reaction to war or neurosis due to underlying conflict were no longer legitimate diagnoses. They were a theoretical in that they did not distinguish between biological or psychological disorders. the D S. M three also listed specific criteria for identifying disorders now. This made it possible to study reliability and validity of the criteria, which means that starting in 1980 is really the first time that research has been able thio over. Multiple studies use the same criteria and um, the same basis for determining whether or not interventions, medications, therapies, etcetera, etcetera are reliable and valid. The D S M three also introduced the multi actual system. The multi actual system enabled clinicians to describe the person's functioning on a number of different dimensions rather than just one disorder. Dimensions that extended beyond the primary diagnosis to include chronic personality disorders, medical conditions related to the disorder, psychosocial stress and a way of establishing functioning were the different axes. And because the process was based on committee decision, social workers were able. Thio pushed for the inclusion of an access three and an access for the medical and ecological factors on DSO again. This is interesting because the D. S M was developed through
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