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Philosophy 2044G - Jan. 29.docx

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Western University
Philosophy 2043F/G
Louis Charland

Philosophy 2044G Wednesday January 29 Outline: I. DSM II. Definition of mental disorder III. DSM-IV IV. DSM-V V. Affecting Disorders VI. Cognitive (Intellectual) Disorders VII. Personality Disorders VIII. DSM 5 Glossary (available under OWL ‘resources’) DSM • For years, people have been trying to classify different types of disorders • We have this manual to try to classify people, and while it works in theory, it can sometimes he hard to categorize someone in practice • The DSMs favour a categorical approach to mental disorder o Categories include: major depression, schizophrenia, anorexia nervosa o Each category is defined by several diagnostic criteria • Scientists have always been classifying things in nature (plants and animals), so mental scientists early on thought it would be a good idea to use this system with mental disorders • When the DSMs first came out, no one agreed what they were talking about (a problem when doing research) o eg. one researcher would call something depression, and someone else would call it melancholia o When researchers wrote their articles, they would use different definitions for certain terms • Requirements of definitions: o Reliability - There was a need for clearer, more reliable definitions  If the definitions weren’t reliable, researchers couldn’t get together and share their research o Validity – a good definition should pick out the things that are real  eg. a good definition of depression should pick out of real cases of depression and exclude anything else  It should yield the same results for the same people under different circumstances • Insurance: In order to ensure consistency with reimbursements in insurance, you had to be able to define things in a consistent and scientifically accurate way • The DSM-III had the first version of statistical categories o Polythetic – when you define a diagnostic category using criteria, the person doesn’t have to have all of the criteria (eg. in classifying major depression), but they can have a combination of symptoms in different ways. This ensures flexibility in the classification process. o The DSM III was a turning point for reliable diagnoses. DSM-IV • The DSM IV has a multi-axial system (axis I, axis II) o There are no axis in DSM V (this is the main change) • Issues in the use of DSM-IV: o There is a misconception that the classification of mental disorders classifies people  They avoid using the word ‘schizophrenic’ or ‘alcoholic’ and instead say ‘an individual with schizophrenia’ or ‘with alcoholism’  A person should be treated with respect – you are a person first, and secondly a person with schizophrenia  eg. sometimes people with anorexia have a hard time wanting to get better because they have always been labelled as an anorexic instead of a person with anorexia  The label can become part of your identity o There is no assumption that each category is a completely discrete entity distinguishing it from other mental disorders  eg. you can have depression and anorexia (they are not mutually exclusive)  This can get confusing if you have 5 mental disorders Definition of Mental Disorders • Disorders of “mentality”, of thinking or feeling • Mental disorders are on axis I, and personality disorders are found on axis II • Most mental disorders have physical effects – the mind and body are connected (mind/body dualism – Rene Descartes) • The authors of the DSM-IV specify that they are talking about mental disorders, even though they recognize that the mind and body are intertwined o They state that they know the term ‘Diagnostic and Statistical Manual of Mental Disorders’ isn’t the right fit, but that they can’t find an appropriate substitute o They use the term ‘mental disorder’ because they can’t find a better term • **The DSM-IV Definition: “In DSM-V, each of the mental disorders is conceptualized as a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (eg. a painful symptom), or a disability (eg. impairment in one or more areas of functioning), or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.” o Note: It would be a good idea to write this down and dissect each of the individual parts o Clinically significant – something that doctors would want to look into, noticeable, marks the boundary between normality and something medical, something you would seek clinical help for (psychology, medical doctors, social workers, occupational therapists)  A mental disorder is something you will try to get help for from someone working in the clinical profession  eg. there are also things (gluttony, other sins) that you wouldn’t go to a psychologist for, you might go to a priest to confess your sins  What counts as clinically significant is not alway
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