Diagnosis of Mental Disorders by Clinical Psychologists - Is it Unethical?

According to their ethical code...which usually becomes part of a state's licensing statutes...the unethics of diagnosing mental disorders by clinical psychologists is a problem.

Clinical psychology has its roots in psychometrics...the scientific measurement of mental functions. The earliest and most commonly known example of this is IQ testing.

For a Ph.D. in clinical psychology...students had to know and use the scientific literature...then to design and carry out publishable scientific research.

If they couldn't...it didn't matter how caring they were in the clinic. They didn't get a Ph.D. because the Code of Ethics For Psychologists -- Standard 2.04 says clearly...

Psychologists' work is based upon established scientific...knowledge of the discipline.

And the 'disorders' in the Diagnostic and Statistical Manual (DSM)...the diagnostic bible...are not determined by scientific investigation. Scientific knowledge is missing in the diagnostic practice of clinical psychology.

A clinical psychologist diagnoses a 'disorder' by matching symptoms to descriptions in the DSM. Good science requires a standard of what's normal before you can decide what is abnormal. But normal and disordered are never defined to differentiate them. So the extent of any 'disorder' can't be measured.

Despite its requirement to be scientific in its activities...the profession became 'medicalized' and adopted the procedures and the jargon of psychiatry -- which has never claimed to be a scientific discipline. It uses borrowed terms like...mental health...psychotherapy...psychopathology...psychiatric diagnosis. And it often relies on medication to manage symptoms in patients.

Why would psychologists use unethical methods?

Unfortunately the incentives...or pressures...are great for psychologists to use unvalidated diagnoses. Insurance companies...who pay psychologists...and the courts...that use them as expert witnesses...put great emphasis on diagnosis of mental disorder.

How could this affect me?

It wouldn't be such a serious matter...except a diagnosis of psychiatric disorder can have unexpected negative consequences in people's lives. When they don't know who uses diagnostic data or how...people even can lose their liberty based on unvalidated disorders.

If you see a clinical psychologist and you use insurance to pay for psychotherapy...a diagnosis is usually required...and may legally be shared with the insurer's affiliated companies.

This data sharing may have negative results (e.g., denial of employment)...which the therapist may not have explored with you. If not...then your agreement to put diagnostic data on the insurance form was not informed consent.

However, the Code of Ethics For Psychologists requires informed consent to share information (Standard 3.10) by discussing...

1. the involvement of third parties (e.g., an insurance company or credit card company and their affiliates) and limits of confidentiality. (Standard 10.01).

2. by discussing the foreseeable uses of the information generated through their psychological activities. (Standard 4.02)

How do I know psychiatric diagnosis isn't scientific?

With the DSM-III the American Psychiatric Association tried to validate the psychiatric diagnosis of 'disorders'...using scientific methods to answer the question: Would clinicians...independently evaluating the same symptoms...arrive at the same diagnosis?

The results were discouraging. Clinician agreement was very variable. This makes almost all mental health diagnoses arbitrary. But they are put in medical records as facts.

And this arbitrariness infects the next edition of the manual (DSM-V). The physicians candidly assert they may never establish the scientific validity of these 'disorders'...

Limitations in the current diagnostic paradigm...embodied in the current

DSM-IV...suggest that future research efforts...exclusively focused on

refining the DSM-defined syndromes...may never be successful...in

uncovering their underlying [causes].

So, the 'disorders' are...and will remain scientifically unreliable opinion.

You can read about the future DSM-V at the url listed below.

How are psychiatric disorders discovered if they're not scientific?

They aren't discovered...most are created. Committees of physicians (and a few non-physicians) decide...intuitively...what a mental disorder is.

For example...if a child is no good at arithmetic...she may be diagnosed with 315.1 Mathematics Disorder. Difficulty with arithmetic may be due to lack of interest. But that's not a disorder. Or it may be due to neurological problems. Which makes it a genuine medical issue...not an arbitrary psychiatric disorder.

What should I do?

You can remember that psychologists are required to practice from established scientific knowledge. They must have your informed consent to share information...such as a diagnosis. So...lacking those things...you should have concerns in this age of massive government and corporate data bases.

And you should raise any concerns about the unethics of diagnosing mental disorders with your psychologist or other therapist. But first know what their ethical requirements are. The url for psychologists is below. For other professions just type into a search engine "ethics for..." and add the name of the profession.

If you and your clinical psychologist haven't discussed these things...which might make you decide not to use insurance benefits...your relationship may be on vague ethical grounds...which are inadequate to protect you...the consumer...from unwanted consequences.

Can I still see a psychologist if I don't want a psychiatric diagnosis?

Of course. It's very doable. And I'll cover how in another article.

Thomas Drummond, Ph.D. is trained in clinical, developmental and neuropsychology. He has worked with the problems of clergy and religious of the catholic church for more than 20 years. The solution to most of their problems was not diagnosis...but definition of proper boundaries in their relationships with people.

Learn more at http://www.boundaries-for-effective-ministry.org

For issues about medical records go to privacyrights.org

For psychologists' ethics http://www.apa.org

For DSM-V issues [http://dsm5.org/planning.cfm]

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