DSM revisited

Foulds’ “Personal Illness Model”

The book used by psychiatrists and psychologists – DSM – is strongly based upon classification. One of the creators of some model was G. Foulds together with A. Bedford about 1975. In 1977 they created an interview model to test Foulds’ Personal Illness Model, named “Delusions-Symptoms-States-Inventory” – DSSI. This and more you can read in my new to be written book.

How is the relation with all the versions of DSM – “Diagnostic and Statistical Manual of Mental Disorders” – about 50 years old now ? If you try to find descriptions about Foulds’ model, then it is hard to find something. Beneath his research B. Skinner developed 5 models as well. He used the empirical way to find this classification system : “the category – dimensional – hierarchic – circular – hybrid model”. All purposes were to organize clinical and diagnostic data and categorize them as far as possible. Of course it was important what criteria were to be applied to come to an acceptable division of classification.

 

The first 3 models of Skinner are important here. The model of categories starts with clients who have strongly identical symptom profiles. Decisions for treatments are based upon an “all-or-nothing” principle (R. Blashfield 1984). An example for this are all DSM manuals. “The Model of Dimensions“ makes decisions based upon the “all-or-nothing” principle. They try to distinguish several dimensions that may represent the relationships between clients. These dimensions are Psychoticism, Neuroticism, Extra- and Introversion. A hierarchical model is a special edition within the categorizes models. A higher specific category and its symptoms implies a lower level within the hierarchy.

The Personal Illness Model of Foulds' refers to a deterioration of the capability of an person concerning dealing his/her illness and being aware of it. According to Foulds the increasing incapability of someone to control his/her own future is to be described within a hierarchy. This hierarchy congregate with a growing disintegration of one’s personality and the growing incapability to have and maintain personal and mutual relationships. His hierarchy has 4 classes over 12 categories.

Class 1 : Affective disruption; “Anxiety-Depression-Elation”

Class 2 : Neurotic symptoms; “Pithiatic (conversion)-Dissociative-Fear (phobia)-Compulsive-Ruminative”

Class 3 : Integrated delusions; “Persecution-Grandeur-Contrition”

Class 4 : Identity disruptions (not specified)

Further specifications about  these aspects and data can be read within the resource at the end of this blog only to keep it easy-reading here. Most striking aspect within all these research based upon interview tests is that they are very unreliable, because often the client is not aware of his/her “problem”. E.g. how is it possible to recall something you forget all the time without being aware of the fact that your mind is free thinking, your energy open and sensitive ? Is this boy of 14 – who lives  at my place this year – really to be diagnosed Autism MCDD or is he just a rebel with an adventurous spirit from an energetic way of looking at him (intuitively as I do) ? Do you label and control him or do I help him unfolding his talents ?

 

Although I somewhere read that DSM isn’t basically a statistical manual, it of course is. Statistics within Mathematics show us the possibility or chance that something happens. Another important term is “probability”. An estimation concerning the probability needs a proper Spelling Horizon. This horizon is our society, our community. Often this Spelling Horizon is an intramural community, where psychiatrists observe their clients. With data from research man creates the Gauss curve. From this Gauss curve the norm is being set, whiat deviation is acceptable and what are the limitations ? As a matter of fact ”science” is able to discover new eccentrics within the behavings of human. So the norm needs to be re-set.

 

There’s a further on-going differentiation within exceptional behavings and so within DSM. This implies that the bandwidth can be changed. The experts – writers of DSM – have the possibility to diminish the norm, the bandwidth of what is being accepted to be normal within their point of view. This means that more and more people have mental illnesses, if you believe these experts, because they do not fulfil the norm. Who finally is still normal or mentally healthy ? How strongly is this related to a free world, where taboos used to be more accepted but because of a more conditioned and controlled society nowadays they do not fit in this world anymore and experts need to give a cognitive explanation for it when expelling free thinking and expressive people ? What interests go beyond the ”need” to diagnose more and more people ill ?

 

(re-source)