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Book part
Publication date: 3 August 2011

Rebecca Godderis

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling…

Abstract

Purpose – There is a paucity of research that examines how diagnostic decisions are made by psychiatrists. Moreover, previous work in the area tends to be grounded in labeling theory, which highlights the conflict-based nature of diagnosis. The goal of this research is to examine the utility and benefits of diagnosis to psychiatrists' everyday work.

Methodology – Using institutional ethnography (IE), I undertook a small-scale interview-based study that documented the diagnostic processes of three psychiatrists in Calgary, Alberta, Canada. The IE-based goals of the study were to: (1) identify what texts were employed during the diagnostic process, (2) map sequences of action and text that coordinated psychiatric decision-making, and (3) theorize the utility of diagnosis for the everyday work of psychiatrists.

Findings – The analysis demonstrates how diagnosis can be understood as a valuable work process that produces a standardized diagnostic story in order to bring an individual's experiences of distress into relation with psychiatrists' daily practices, and institutional discourses more generally.

Limitations – Although IE-based research does not depend on large sample sizes for analytic accuracy, results from the current study need to be replicated because of the limited number of interview participants and to examine whether the diagnostic process is generalizable to other settings.

Social implications – This research challenges the idea that standardization through diagnosis is a negative process and highlights the value of diagnostic decision-making in the daily work of psychiatrists.

Details

Sociology of Diagnosis
Type: Book
ISBN: 978-0-85724-575-5

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Health and Illness in the Neoliberal Era in Europe
Type: Book
ISBN: 978-1-83909-119-3

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Mad Muse: The Mental Illness Memoir in a Writer's Life and Work
Type: Book
ISBN: 978-1-78973-810-0

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Mad Muse: The Mental Illness Memoir in a Writer's Life and Work
Type: Book
ISBN: 978-1-78973-810-0

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Mad Muse: The Mental Illness Memoir in a Writer's Life and Work
Type: Book
ISBN: 978-1-78973-810-0

Book part
Publication date: 8 June 2020

Florence Gwendolyn Rose and Tony Leiba

Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care…

Abstract

Mental health is an underdeveloped service to the population generally and to African-Caribbean in particular. There is a need for more sensitive diagnosing, treatment and care. African-Caribbean people are asking for a more culturally competent mental healthcare system.

This chapter aims to address the following issues: how African-Caribbean people reflect on mental health and mental ill health. Their reflections are drawn from interviews done with African-Caribbean people who are involved with Hagar, a mental health charity in Lewisham, London. Mental health and mental illnesses will be examined, followed by the Psychiatrists’ use of the diagnostic tools that do a disservice to Black people. The Trans-Atlantic slave trade and its contribution to the mental ill health of Black people will be addressed, thus providing a historical underpinning for much of Black people’s struggle with mental ill health. Racism and its contribution to mental health issues will be presented. The views of the Black Psychiatrist Franz Fanon will be argued as a way of understanding oppression, alienation and mental ill health in Black people, and going on to open up ways of providing treatment and care. Finally suggestions will be made about how to provide a culturally competent mental health service to African Heritage peoples.

Details

The International Handbook of Black Community Mental Health
Type: Book
ISBN: 978-1-83909-965-6

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Book part
Publication date: 14 December 2018

Joanna Tegnerowicz

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence…

Abstract

The aim of this article is an analysis of the links between race and psychotic illness, psychiatric diagnosis and treatment, as well as psychiatric, police and prison violence against people with mental health problems. The analysis focuses on Black men who are more frequently diagnosed with schizophrenia and other psychotic disorders and who face more brutal treatment than other people with such diagnoses. We have adopted a multidisciplinary approach which draws insights from psychiatry, psychology, and sociology and challenges the biologistic interpretation of “mental illness.” We take into account the United States and Britain – two countries with large Black minorities and an established tradition of research on these groups. Among the crucial findings of this study are the facts that racial bias and stereotypes heavily influence the way Black men with a diagnosis of psychotic illness are treated by the psychiatric system, police and prison staff, and that the dominant approach to psychosis masks the connections between racism and mental health.

Details

Inequality, Crime, and Health Among African American Males
Type: Book
ISBN: 978-1-78635-051-0

Keywords

Book part
Publication date: 3 August 2011

Manuel Vallée

Purpose – This chapter has two central purposes. The first is to suggest that western, as well as non-western, illness categories are culture bound. The second is to elucidate the…

Abstract

Purpose – This chapter has two central purposes. The first is to suggest that western, as well as non-western, illness categories are culture bound. The second is to elucidate the diagnostic and treatment implications associated with adopting a reductionistic diagnostic approach, including for psychiatric as well as nonpsychiatric illnesses.

Approach – A comparative approach is used to highlight the differences between American psychiatry's diagnostic system (i.e., DSM) and French child psychiatry's diagnostic system (CFTMEA). The analysis begins by identifying the overarching differences between the systems, then analyzes the differences between their respective versions of the Attention Deficit/Hyperactivity Disorder diagnostic category, and ends by tracing the diagnostic and treatment implications of those differences.

Findings – This analysis reveals that the systems differ in three significant ways: (1) theoretical orientation (biological vs. psychodynamic), (2) the view that symptoms should be counted as opposed to understood, and (3) the presence of symptom checklists versus their absence. Additionally, these differences encourage American clinicians to both administer the ADHD diagnosis to a greater number of symptomatic children and to treat these children with psychiatric medications.

Contributions to the field – The analysis makes three contributions to the field: (1) the comparative analysis highlights the limitations of the DSM's ADHD definition; (2) it strengthens the case for seeing western diagnostic categories in general, and the DSM categories in particular, as cultural artifacts; (3) it elucidates the profound relationship between diagnostic systems and both diagnostic rates and treatment practices.

Details

Sociology of Diagnosis
Type: Book
ISBN: 978-0-85724-575-5

Keywords

Book part
Publication date: 4 July 2016

Sandra H. Sulzer, Gracie Jackson and Ashelee Yang

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

Abstract

Purpose

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

Methodology/approach

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Findings

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

Originality/value

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

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