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Discussion: Diagnostic Labels as Powerful Communications

A diagnosis is powerful in the effect it can have on a person’s life and treatment protocol. When working with a client, a social worker must make important decisions—not only about the diagnostic label itself but about whom to tell and when. In this Discussion, you evaluate the use and communication of a diagnosis in a case study.

To prepare: Focus on the complex but precise definition of a mental disorder in the DSM-5 and the concept of dimensionality both there and in the Paris (2015) and Lasalvia (2015) readings. Also note that the definition of a mental disorder includes a set of caveats and recommendations to help find the boundary between normal distress and a mental disorder.

Then consider the following case:

Ms. Evans, age 27, was awaiting honorable discharge from her service in Iraq with the U.S. Navy when her colleagues noticed that she looked increasingly fearful and was talking about hearing voices telling her that the world was going to be destroyed in 2020. With Ms. Evans’s permission, the evaluating [social worker] interviewed one of her closest colleagues, who indicated that Ms. Evans has not been taking good care of herself for several months. Ms. Evans said she was depressed.

The [social worker] also learned that Ms. Evans’s performance of her military job duties had declined during this time and that her commanding officer had recommended to Ms. Evans that she be evaluated by a psychiatrist approximately 2 weeks earlier, for possible depression.

On interview, Ms. Evans endorsed believing the world was going to end soon and indicated that several times she has heard an audible voice that repeats this information. She has a maternal uncle with schizophrenia, and her mother has a diagnosis of bipolar I disorder. Ms. Evans’s toxicology screen is positive for tetrahydrocannabinol (THC). The evaluating [social worker] informs Ms. Evans that she is making a tentative diagnosis of schizophrenia.

Source: Roberts, L. W., & Trockel, M. (2015). Case example: Importance of refining a diagnostic hypothesis. In L. W. Roberts & A. K. Louie (Eds.), Study guide to DSM-5 (pp. 6–7). Arlington, VA: American Psychiatric Publishing.

Study Guide to DSM-5(r), by Roberts, M.; Louie, A.; Weiss, L. Copyright 2015 by American Psychiatric Association. Reprinted by permission of American Psychiatric Association via the Copyright Clearance Center.

Provide a Discussion Post of at least 400-word response stating the following Topics, Content, and Headings.

Discuss how a social worker should approach the diagnosis. 

In your analysis, consider the following questions:

· Identify the symptoms or “red flags” in the case study that may be evaluated for a possible mental health disorder.

· Should the social worker have shared this suspected diagnosis based on the limited assessment with Ms. Evans at this time?

· Explain the potential impact of this diagnosis immediately and over time if the “tentative” diagnosis is a misdiagnosis.

· When may it be appropriate to use a provisional diagnosis? 

· When would you diagnosis as other specified and unspecified disorders?

Must have at least 4 references from the above-mentioned materials. Absolutely reference Paris (2015), Lasalvia (2015, and American Psychiatric Association (2013) DSM-5

Week 1: The Risks and Benefits of Diagnosis

Understanding the definitions and conceptualizations of various psychopathologies is imperative when practicing as a social worker. As part of a multidisciplinary team, a social worker needs to be able to recognize patterns of illness and discuss a client’s diagnosis. Social workers in clinical settings also need to understand how a diagnosis should be developed and applied in an ethical, professional, and client-centered manner.

While cultures vary widely in their approach to mental health and to different mental disorders, there are many common barriers to help-seeking and to accurate diagnosis. Chief among those barriers, across nations and cultures, is the stigma associated with receiving a diagnostic label. Two different types of stigma are public stigma (consisting of stereotypes; allegiance to mistaken beliefs; and reactive, discriminating behaviors) and self-stigma (the internalized beliefs that result from repeated stigmatizing thoughts).

This week you consider the impact of both types of stigma and the risks and benefits of using any diagnostic label.

Learning Objectives

Students will:

· Analyze use of diagnostic labels in professional and lay environments

· Analyze influence of stigma on experience with and treatment of mental illness

Learning Resources

Required Readings

Paris, J. (2015). The intelligent clinician’s guide to the DSM-5 (2nd ed.). New York, NY: Oxford University Press

· Chapter 4, “What Is (and Is Not) a Mental Disorder” (pp. 54–69)

Pillay, S. (2010, May 3). The dangers of self-diagnosis: How self-diagnosis can lead you down the wrong path [Blog post]. Retrieved from https://www.psychologytoday.com/blog/debunking-myths-the-mind/201005/the-dangers-self-diagnosis

Campbell, R. D., & Mowbray, O. (2016). The stigma of depression: Black American experiences. Journal of Ethnic & Cultural Diversity in Social Work, 25(4), 153–269. doi:10.1080/15313204.2016.1187101

Corrigan, P. W., & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57(8), 464–469. doi:10.1177/070674371205700804

Document: How to Upload a Video and a Transcript (PDF)

Required Media

Accessible player 

Laureate Education (Producer). (2018a). Psychopathology and diagnosis for social work practice podcast: Diagnosis, self-stigma, and mental health [Audio podcast]. Baltimore, MD: Author.

TED Conferences, LLC (Producer). (2017). There’s no shame in taking care of your mental health [Video file]. Retrieved from https://www.ted.com/talks/sangu_delle_there_s_no_shame_in_taking_care_of_your_mental_health

Optional Resources

Corrigan, P. W. (2007) How clinical diagnosis might exacerbate the stigma of mental illness. Social Work, 52(1), 31–39. doi:10.1093/sw/52.1.31

Johnson, J. L., Oliffe, J. L., Kelly, M. T., Galdas, P., & Ogrodniczuk, J. S. (2012). Men’s discourses of help‐seeking in the context of depression. Sociology of Health & Illness, 34(3), 345–361. doi:10.1111/j.1467-9566.2011.01372.x

Muralidharan, A., Lucksted, A., Medoff, D.,
Fang, L. J., & Dixon, L. (2016). Stigma: A unique source of distress for family members of individuals with mental illness. Journal of Behavioral Health Services & Research, 43(3), 484–493. doi:10.1007/s11414-014-9437-4

Tsang, H. W. H., Ching, S. C., Tang, K. H., Lam, H. T., Law, P. Y. Y., & Wan, C. N. (2016). Therapeutic intervention for internalized stigma of severe mental illness: A systematic review and meta-analysis. Schizophrenia Research. 173(1-2), 45–53. doi:10.1016/j.schres.2016.02.013

Document: Suggested Further Reading for SOCW 6090 (PDF)

Note: Throughout the course, you may take the opportunity to read more about many of the topics covered. This document has a list of suggested further readings organized by course week. This same document will be linked in each week.

Assignment: Diagnosis: The Burden of Stigma in Help Seeking

The threat of public stigma, as well as self-stigma, can prevent individuals from receiving the mental health treatment they need. In this Assignment, you analyze the influence of stigma on experiences with and treatment of mental illness.

To prepare: Watch the TED Talk by Sangu Delle and then review the readings for this week. Focus on Delle’s examples illustrating Corrigan’s model about the stages of stigma and the hierarchy of disclosure. Consider Delle’s experience against that model.

Submit a 2- 3-page paper that addresses the following topics, content, and headings:

· Briefly explain Corrigan’s model of the stages of stigma and his recommendations and hierarchy about recovery.

· Explain whether Delle’s experience follows that model. Use specific examples to argue your perspective. If you agree, identify which stage of recovery Delle is in.

· Analyze Delle’s reports about his own experiences with both types of stigma. Provide specific examples, and in your analysis consider the following questions:

· Does one type of stigma predominate in his talk?

· Which of Delle’s personal values or beliefs were challenged by his internalizations about his own illness and help-seeking?

· What strengths does he exhibit?

· What was the primary benefit of his diagnosis?

· Do you think his experience would be different if his culture was different? Explain why or why not?

Must contain at least 4 references and citations from the stated materials especially the TED Talk by Sangu Delle and the readings for this week. Focus on Delle’s examples illustrating Corrigan’s model about the stages of stigma and the hierarchy of disclosure