Review of David G. Phillips (2013) “Clinical social workers as Diagnosticians: legal and ethical issues”
Article summary
David G. Phillips in his article “clinical social workers as Diagnosticians: legal and ethical issues” 2003, describes the issues associated with the diagnosis of mental illness. He notes that since 1980, there have been many changes in the practice of clinical social workers that included the medicalization of the diagnosis. Such trends began with the publication of the third edition of DSM-III. The trend was accelerated by the involvement of insurance systems for both the government and private organizations that required proof of the necessity of treatment. After DSM-III, DSM-IV followed, and by the time of publication of the article, DSM V was due for publishing. The insurance systems and medical care could change from the DSM-V and switch to the international classification of Disorders (ICD-10). Changes in DSM-V may not make it any better.
There are several criticisms of the DSM-V as a diagnostic tool as well the procedures used by the clinical social workers to diagnose a mental disorder. After second world war, the American psychiatry us to try and analyses the meaning of a symptom and determine its cause rather than manipulate it directly. Such approaches lead to the development of DSM-I. DSM I was followed by DSM II and DSM III. However, even with more refining, there arose several controversial issues that surrounded the diagnosis of mental disorder. It emerged that two social workers would not have a direct agreement on the diagnosis of the same patient. There was subjective influence on the social workers such as the environment the social worker found the patient, as well as social-cultural influence. The diagnosis of patients by the social workers without consulting a physician was termed a “malpractice” and had led to misdiagnosis. It is because there was a need to avoid organic causes of mental disorders. DSM v was more refined than the previous DSMs. The use and not to use of insurance during often infuriated patients claiming they were able to use it in the previous. The autonomy of the patient is also compromised.
Importance of the article to social workers
The article is important to social workers in various ways. First, it gives the historical development of the methods and procedures set out in the diagnosis of people with mental disorders. It also gives the main driving force that made the current methods used to begin. In this case, insurers and other medical practitioners wanted a proof or an explanation as to the need of the treatment. Such decisions influenced the economic dynamics of the insurance companies. It is inferred from the article that at that time, the diagnosis and treatment mental disorders was not accurate enough to be accepted by the medical practices. The article also gives the criticism that has been advanced towards the use the various methods mentioned.
The DSM I to V have had many challenges in there usage. Such dynamics as explained are the ones that have a lead to continuous and steady improvement and refining of the diagnostic criteria. Such criticisms are very informative to the social worker who is expected to actively reject subjectivity. For example, the subjectivity of the DSM-I and II meant that two social workers had a very little chance of agreeing on a diagnosis of the same person. Such situations are very embarrassing and the social workers would wish not to be caught such a trap. It is such shortcomings that lead to DSM III-R, DSM-IV, and DSM-IV that where more objective and specific in the diagnosis of a person. The later DSMs moved from the psychosocial assessment to medical model.
Understanding the difference in the DSM plays a crucial role in the diagnosis of the patients. The social workers and the practitioners are made aware of the shortcomings in each of the DSM, and thus would make a more informed choice. Such a divergence from the DSMs, although it took a shorter period to design, is inevitable in the current trend of globalization and technological advancement. Nevertheless, since DSM V is due, it would bring the initial changes required in the diagnosis of mental illnesses.
The article brings into attention the possible pitfalls that social workers fell in. For example, the article attributes some of the decisions influenced by the social workers judgment that is attached to the environment and/or other physical characteristics during the initial encounter. Knowledge on such pitfalls are important since they would make the social workers more informed of their roles, duties and the need to avoid subjectivity in making judgments on mental illness. In this case, such information forms the foundation of deciding whether ones need to be examined for mental illness or not i.e. making the wrong inferences based on environmental factors. The understanding of the demands from the insurers makes the diagnosis and the process of diagnosis of mental illness very critical and done in a scientific way hence benefiting both the client and the social workers.
Impacts of the article to my practice
This article has many impacts on my practice. These impacts range from great awaking to pragmatic approached that are articulated in the article. First, I have known the history of the DSM-I-V and the major driving force behind it. Although the main drive was external, i.e. from without the social workers, the issues raised are very critical and have led to critical changes over time.
The article has brought to my attention the possible pitfalls that the early social workers fell into in the attempt of diagnosing a patient. Such pitfall such as giving one’s opinion based on the environment of first encounter would lead to wrong diagnosis or decision. Since it is common knowledge that before diagnosis is made, the patient has to either be noticed, or brought into the hospital, the decisions to test for mental disorders lies on the social workers or the medical practitioners. Armed the knowledge obtained from the article, I would reduce chances of making mistakes by inferring to personal views. I have learned that there are various aspects such as the culture, diversity, spiritual and religious affiliations as well as the social justice are a priotize by social workers, but are not the only aspects that are associated with mental disorders.
The article also articulates the continuity that has existed in the development of the mental disorder diagnosis criteria as well as the criticism associated with them. Knowing the criticisms of the DSMs would be helpful since one would be in a position to rectify such pitfalls as described. Without such knowledge one would continually fall in the same trap. It is also important for one to keep on tracking the new developments and hence including the new methods in the progressive DSM. Such knowledge would help me to avoid been ignorant and hence stick to using obsolete methods.
It is clear in the article that the need for clear information on the client’s problem, severity of the problem, the need for treatment, the prognosis thereof and the benefits of the treatment need to be properly documented so as the insurers would accept the claims. Therefore, the article put me in the know that such details need to be provided. A critical point also arises on the importance of physicians in the diagnosis of mental disorders, such is very important since the mental disorder may be caused by pathogens.
The article informs me of the possible criticisms that I would face either directly or through literature like this. It thus prepares me psychologically to be ready for such criticism and take them positive. Any work without criticism may lack the impetus required for continued development and upgrading.
Reference
Phillips, D. G. (2013). Clinical Social Workers as Diagnosticians: Legal and Ethical Issues. Clinical Social Work Journal
