You paint a dismal picture of diagnosis. Is there any place for diagnosis in brief outcome-informed intervention?
A word carries far—very far—deals destruction through time as the bullets go flying through space. —Joseph Conrad
This information is adapted from Chapter 8 of the book:
Murphy, J. J., & Duncan, B. L. (2007). Brief intervention for school problems (2nd ed.): Outcome-informed strategies. New York: Guilford Press. (www.guilford.com)
Simply put, diagnosis has never lived up to its original billing. Although it continues to serve logistical functions such as meeting state requirements or receiving third-party payments, none of this is related to client outcomes. Diagnosis of psychological and behavioral problems is highly unreliable and invalid, especially with children and adolescents. Diagnosis fails to reliably distinguish between the so-called pathological states themselves, or between these disorders and normal development variations or problems of living. Given these validity and reliability problems, it should come as no surprise that diagnosis has also fallen short on its promise to predict outcomes and select interventions.
Despite scientific evidence and practitioner concerns about the usefulness of diagnosis, old habits are hard to break as evidenced by the growing number of disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Whereas the original DSM included 66 diagnoses (American Psychiatric Association, 1952), the newest version includes 397 disorders (DSM-IV-TR; American Psychiatric Association, 2000). That’s an increase of 600%, or about 7 new categories per year, over the past 50 years! Are we really becoming that disturbed, or has the profession’s fascination with diagnosis spiraled out of control?
I view diagnosis as unnecessary and sometimes harmful to the change process. As a vestige of the medical model and biological psychiatry, diagnosis implies that the problem resides within the client. This is problematic in several ways. In addition to lacking empirical support as a predictive or prescriptive tool (see Chapter Seven), diagnosis de-emphasizes the impact of situational and environmental influences. Diagnosis blinds children and caregivers to common-sense interventions and actions based on their own ideas and resources—modifying classroom instruction, changing parenting practices, altering study habits, and so forth. Diagnosis can also reduce accountability and persistence in problem-solving. I have seen parents, teachers, and students become discouraged and give up in the face of medical “disorders” that appear impervious to everyday solutions.
I am not denying the pain of serious problems or the importance of people’s struggles. Some people do experience a sense of relief from being able to name the problem. I would never take that away from them. That being said, my experience has led me to view diagnosis as more of a hindrance than a help in promoting change in most situations.