The Assumptive Worlds of Psychopathy VII: Clinical Diagnosis and DSM
In this, our sixth essay, we are arriving at the heart of the matter regarding contemporary perspectives on psychopathy. Here is where “the rubber hits the road”—for it impacts in a significant manner on the financing of mental health services in the United States and many other countries in the world. It is in the basic act of diagnosing and categorizing the psychopathy of a client seeking treatment that not only the nature of treatment is being determined (in many instances), but also the length of treatment and role played by other professionals (such as psychiatrists, clinical social workers and counsellors) are determined (or at least strongly influenced). We are referring specifically to the critical role played by the Diagnostic and Statistical Manual of Mental Disorders, which is now in its fifth edition—hence is usually referred to as DSM-5 (American Psychiatric Association, 2013).
There is often a “love/hate” relationship between DSM (in its many versions) and the mental health community. While DSM is a useful guide in determining treatment options and is certainly important for many clinicians who look to third-party and/or government reimbursements to keep their practices financially viable, they frequently find DSM to be an infringement on their rights and privileges as a licensed professional.
As I will note later, DSM (like many of the current “evidence-based” tools used in present day medicine), tends to fly directly in the face of the norms of autonomy and authority that is to be found in the professional culture operating in the world of both physical and mental health (Bergquist, Guest and Rooney, 2002). As I noted in our fifth essay (Bergquist, 2020), the emergence of a strong set of assumptions regarding psychopathy as a “mental illness” led to a framing of emotional (and spiritual) disturbances in medical terms. With this reframing, it was only to be expected that the emphasis in medicine on diagnosis and classification would accompany and, in many ways, dominate the contemporary practices of many workers in the field of “mental” health.