I found an interesting article where a psychiatrist talks about the difference between diagnosis by inner experience vs. diagnosis by external behaviors. He mostly discusses psychopathy, but it should be interesting nonetheless. I found the following two paragraphs to be fascinating:
Unfortunately, the American Psychological Association seems not just uninterested, but actively hostile to the approach of depth psychology which attempts to investigate not only behavior, but also motivation and inner experience. The APA definitions of personality disorders promulgated in the DSM are based almost entirely on observation of external behaviors, showing little or no interest in the inner, emotional world of the person to be diagnosed. For example, the criteria set for a diagnosis of APD includes such phrases as "failure to conform to social norms," "repeatedly performing acts that are grounds for arrest," and "irritability and aggressiveness, as indicated by repeated physical fights or assaults," while including only one mention of an intrapsychic characteristic--"lack of remorse"--and this one item, which is a central feature of psychopathy, is not even required to make the diagnosis. And so we now have conduct disorder and antisocial personality disorder, but no psychopathy.
By the way, as a depth psychologist who is profoundly interested in human motivation and inner experience, and who considers that a diagnosis demands an understanding of the psychodynamics of the patient as well as his or her behavior, I rarely use the DSM in my own practice—the last time I consulted it I had, literally, to wipe away the dust first. Regrettably, because almost all insurance companies demand a DSM diagnosis before they will pay for services, the DSM has become hugely influential, and distorts terribly, in my experience, the way that many psychologists and psychiatrists understand and treat their patients.
The article itself is here:
http://askdrrobert.dr-robert.com/mildpsychopath.html
22 Nov 2010, 4:06 am
