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Focus on learning and behavior

How conditions and consequences shape learning and behavior

Studies observable behavior instead of internal processes such as thought or feelings

Key theorists: Pavlov, Watson, Thorndike, and Skinner

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[Episode 12] In this lecture, I focus on the concepts of stimulus and response, rewards and punishments, and how these concepts make operant conditioning such a powerful approach to behavior change. Also in this lecture I touch on classical conditioning, social learning theory and cognitive behavior therapy. The role of the therapist, client, expectations for treatment, implications for multicultural treatment, and the strengths and limitations of the approach are covered.

Download MP3 [41:05]

References
Rychlak, J. F. (1981). Introduction to personality and psychotherapy (2nd ed.). Boston: Houghton Mifflin Company.

Skinner, B. F. (1953). Science and human behavior. New York: Free Press.

Bandura, A. (1977). Social learning theory. Englewood Cliffs, N.J.: Prentice-Hall.

Burke, J. F. (1989). Contemporary approaches to psychotherapy & counseling: The self-regulation and maturity model. Belmont, CA: Wadsworth Press.

Corey, G. (2005).
Theory and practice of counseling and psychotherapy (7th ed). Belmont, CA: Wadsworth/Thomson.
Kazdin, A. E. (2005).
Parent management training: Treatment for oppositional, aggressive, and antisocial behavior in children and adolescents. New York: Oxford University Press.
Rubin, A., Bischofshausen, S., Conroy-Moore, K., Dennis, B., Hastie, M., Melnick, L. et al. (2001). The effectiveness of EMDR in a child guidance center. Research on Social Work Practice, 11(4), 435-457.

APA (6th ed) citation for this podcast:

Singer, J. B. (Host). (2007, March 12). Behavior therapy [Episode 12]. Social Work Podcast. Podcast retrieved Month Day, Year, from http://socialworkpodcast.com/2007/03/behavior-therapy.html

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the social work podcast: behavior therapy

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Episode 12] In this lecture, I focus on the concepts of stimulus and response, rewards and punishments, and how these concepts make operant conditioning such a powerful approach to behavior change. Also in this lecture I touch on classical conditioning, social learning theory and cognitive behavior therapy.

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Through repetition, a neutral stimulus such as a bell paired with an unconditional stimuli (naturally occurring such as food) can produce same response (salivating) as the unconditional stimuli

The stimulus and Response paradigm became scientific because of Pavlov’s strict experiments and systematic data collection

Association with the stimulus is central to learning and behavior changes

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Took Pavlov’s Stimulus and Response paradigm and applied it to the world of psychology

Defined behaviorism as “a natural science aimed at the prediction and control of human behavior and held that behavior could be shaped through the selection and application of appropriate stimuli” (RCC 347)

Association through repetition within the stimuli and response paradigm form a habit (RCC 347)

Rejected the role of heredity and mentalism which asserts internal workings typically of the mind are key to understanding behavior, i.e. Freud (RCC 347)

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Took the Stimulus and Response (S-R) paradigm and developed the idea that consequences strengthen or weaken the S-R connection

Consequences either satisfy (making it sought after) or annoy (making it avoided) the learner but either way the connection is “stamped in” or reinforced which is the Law of Effect (RCC 348)

Moved beyond associated learning and conditioned reflexes (his critique of Pavlov) to behavioral consequences which function to change a person’s internal nature and behavior (RCC 348)

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Uploaded by Armavic Dyn Mamigo on 2013-09-14.

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Accepted the Stimulus and Response paradigm but held it is the simplest example of learned behavior

Believed that person and environment relations were too complex to be understood in reflexive terms

Developed the idea of operant conditioning which focuses on consequences or what happens after the behavior creating a learning dynamic in which behavior is “strengthened by its consequence and the consequence itself is the reinforce for the behavior” (RCC 349)

Positive reinforcement adds something to the environment and negative reinforcement removes something from the environment which strengthen the desired behavior/response

Punishment weakens the desired behavior/response through giving an unwanted consequence or removing a positive reinforcement

Reduced the importance of the stimulus (known as the antecedent) in explaining human behavior

Continued to emphasize the experimental processes and date collection and analysis giving scientific credibility to the field

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In the classroom

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with adults living in poverty through changing the operating conditions

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Change Behavior- Change the World: Joseph Grenny at TEDxBYU

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Joseph Grenny, New York Times bestselling author and behavior change expert, tells the story of Jane, a woman born in the Mathare Slum in Nairobi, Kenya. As a child, Jane was sexually molested by her father, had her first baby at age 13, is now a mother of four, worked as a prostitute to support her family on 50 cents a day, and is HIV positive.

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with children who have autism

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My son and I doing ABA therapy at home. Our therapist has been training me for just a few weeks now so we're far from perfect at it. I plan to update his progress every few weeks or so.

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Social Learning Theory -- The Original Bobo Doll Experiment

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Social Learning Theory -- The Original Bobo Doll Experiment

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Social Learning Theory, developed by Robert L. Burgess and Ronald L. Akers (1966), is based on the notion that learning comes from observing and imitating the actions of others.

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Is aggression a learned behavior?  If so, how do we learn this behavior and why?

Social Learning Theory states that children learn aggressive behavior by observing other children’s aggressive actions.  Children learn that, under certain circumstances, the reward for aggressive (or criminal) behavior is greater than the punishment (vicarious reinforcement). The aggressive behavior will be repeated depending upon the success (or reward) that a child receives from acts of aggression (self- efficacy).

A strength of Social Learning Theory is that it can explain context dependent aggression or aggressive behavior that occurs without direct reinforcement.

Social Learning Theory can also explain causal links between media and real-life aggression.  However, there is much debate about how influential media is relative to aggressive behavior by real people in everyday life.

Will playing video games lead a child to murder?  Do violent movies play a role in domestic violence?  These questions are highly debated and continue to be explored today.

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We all participate in social learning every day. For example, here is a contemporary example of Social Learning Theory in action with regard to Youtube instructional videos. When we want to learn how to do something, we often simply watch and imitate the actions of others who post instructional videos on the internet.

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DSM stands for Diagnostic and Statistical Manual for Mental Disorders. It is the manual published by the American Psychiatric Association which lists all classifications of mental disorders.

The organizing concept of the DSM is to assign symptoms to the classification for which they are most relevant. For example, even if obsessive symptoms are frequently found with the manic/depressive symptoms of bipolar disorder, they would nevertheless be categorized with obsessive-compulsive disorder as they are more relevant to that category.

Each classification contains threshold criteria for the symptoms it includes; that is, the length and/or severity which are needed for that symptom to qualify for the diagnosis.

From time to time, the classifications are updated in order to incorporate new knowledge.

The DSM has been enormously helpful in that it has created a single “language” with which to discuss, collaborate and diagnosis mental disorders.

Despite this usefulness, the classifications in the DSM have not led to any major research breakthroughs. They remain concepts, or ideas of mental disorders, rather than evidence-based, validated classifications linked to known biological conditions.

Investigators continue in their efforts to define mental disorders in ways that will provide that validation.

There is growing recognition that the organizing concepts of the DSM are largely at odds with how our brains create behavior and that meaningful research will not be accomplished as long as it is based on DSM classifications.

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April 7, 2013

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When the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders hits the stores on May 22nd, it will signal the end of a fraught thirteen-year campaign. Every revision of the D.S.M. causes controversy; that's what happens when experts argue in public about the nature of human suffering. But never has the process provoked warfare so brutal, with attacks coming from within the profession as well from psychiatry's usual opponents. Indeed, it's possible that no book has ever been subject to such scrutiny in the course of being written. It is as if J. K. Rowling had produced her Harry Potter sequels in a glass studio with fans looking on and banging the windows whenever she typed something they didn't like.

All the critics seem to agree on one thing, which is that the D.S.M.-5 will "extend the reach of psychiatry" further into daily life. That complaint has even united the psychiatrist who ran the last revision with the Church of Scientology. The new book will make many more of us eligible for psychiatric diagnoses, they argue, and thus for even more drugs than we are already taking. ( More than ten per cent of American adults take antidepressants.)

But there is little reason to think that a new D.S.M. will increase the prevalence of mental-disorder diagnoses, and less to think that we will ever really know how many people are sick. Psychiatrists have never been able to establish the line between mental health and mental illness. As a result, ever since 1840, when the U.S. Census Office first asked states for an accounting of the mentally ill, doctors have been hard pressed to know how to supply it. Most counting methods have yielded suspicious results. The 1961 Midtown Manhattan Study, for instance, indicated that nearly eighty-five per cent of New Yorkers had some degree of mental disorder, a number that beggars common sense, unless perhaps you're a Woody Allen fan.

The first edition of the D.S.M., published in 1952, was in effect at the time of the Midtown Manhattan study, but the researchers did not use it. They weren't as interested in counting the mentally ill as they were in how many people suffered psychological distress of any kind or degree, and even if they had been, the disorders it listed did not have criteria that could easily be turned into survey questions. But the D.S.M.-III, issued in 1980, provided a set of criteria for each disorder (as has every D.S.M. since then), and epidemiologists almost immediately created test instruments keyed to the new manual. In 1992, they concluded that about twenty-two per cent of Americans would qualify for a D.S.M.-III diagnosis in any given year, and thirty-three per cent of us in our lifetimes. By that time, however, the D.S.M.-IIIR ("R" for "revision") had been published, and, in 1994, a different research group, using the newer manual and an entirely different survey, turned up a one-year prevalence of 29.5 per cent and a lifetime prevalence of forty-eight per cent. That study came out just in time for the A.P.A. to release yet another manual, the D.S.M.-IV. And in 2005, researchers using the D.S.M.-IV found rates of twenty-six per cent in a year and forty-six per cent lifetime.

No one knows exactly what effect, if any, revisions to the D.S.M. have on these numbers. According to Ronald Kessler, the Harvard epidemiologist who ran the 1994 and 2005 projects, this "wasn't a question we set out to answer." Questioning all patients with both sets of criteria and then analyzing the results was an undertaking that would have distracted from other efforts, and, he adds, D.S.M.-related overdiagnosis just wasn't a "burning issue" at the time. It is now, of course, but the A.P.A. didn't directly address the question as it field-tested the D.S.M.-5.

Still, some tentative conclusions can be drawn. Michael First, a psychiatrist at Columbia and leading D.S.M. researcher, thinks the sharp increase between the D.S.M.-III and the D.S.M.-IIIR results has little to do with changes to the manual. "The prevalence appears to have changed," he told me, "but this is most likely due to the differences between the instruments used to conduct the study." N.Y.U.'s Jerome Wakefield, who has closely compared the two studies, explained that the earlier study "seemed to have a glitch. Subjects realized that if they answered yes to a general question they would then be asked a lot of detailed questions on the same subject, so they tended to say no as the interview wore on." In the D.S.M.-IIIR study, researchers asked all the general questions up front and then moved on to specifics. Researchers used the same approach in the D.S.M.-IV study, and although the manual had added such popular diagnoses as Asperger's syndrome and relaxed criteria for bipolar disorder and A.D.H.D., the overall prevalence barely budged. How many of us qualify as mentally ill appears to have more to do with how you count than with how many diagnoses are available.

The D.S.M.-5 is not likely to change that. Nor will it necessarily lead to more drugging of the populace. Drug companies are sure to seize on new diagnostic labels to get lucrative indications for their drugs, which they will then advertise to consumers who will in turn request the drugs from their doctors. But that won't necessarily translate into an increase in diagnoses. Doctors don't have to render diagnoses when they reach for the prescription pad. Seventy-two per cent of antidepressant prescriptions, for instance, are written in the absence of a psychiatric diagnosis. Indeed, disregarding the D.S.M.'s particulars may be the industry standard. As one D.S.M.-5 committee member told her colleagues at the A.P.A.'s annual meeting in May, "If the clinician's gut feeling is that the patient has the disorder, it's appropriate for them to get it [the diagnosis]." The D.S.M.-5 may only provide doctors with a new manual to ignore.

What will change with a revision is the prevalence of specific diagnoses. Come May 22nd, there will surely be more children diagnosed with disruptive mood dysregulation disorder, since that is a category new to the D.S.M.-5. And the prevalence of Asperger's syndrome will certainly drop to zero, as the diagnosis is being eliminated. But the D.M.D.D. kids are probably already diagnosed with bipolar disorder or some other mental illness, and many of the displaced Aspies may end up on the autism spectrum created for the D.S.M.-5. Adding or subtracting a diagnostic label won't necessarily change the overall prevalence of mental disorders any more than putting out a new Chevrolet model or eliminating the Oldsmobile badge would change the number of drivers.

The market for mental disorders is already enormous, thanks in part to the relentless effort of the A.P.A. to use the D.S.M. to convince us that our psychological suffering is best understood as diseases that should be treated by doctors. Psychiatrists don't need any more disorders to expand the market; they only need franchise that allows them to dole out the diagnoses. Doctor or patient, we can all browse the updated catalog just as easily as we could the previous one-and as easily as we can browse Amazon for a book or video.

Of course, there are a couple of differences between G.M. or Amazon and the A.P.A. Cars and books are real, physical things; even by the A.P.A.'s own account, the D.S.M. 's categories are only useful constructs, the best psychiatrists can do until they figure out how to identify and classify mental illnesses in the same way other specialists now identify physical diseases. And the A.P.A., unlike those companies, has a monopoly on its market.

The D.S.M. has enormous impact on the public health. It determines which conditions insurers will cover, which drugs regulators will approve, which children will receive special-education services, and which criminal defendants will be able to stand trial and, in some cases, how they will be sentenced. Psychiatry has already reached far into our daily lives, and it's not by virtue of the particulars of any given D.S.M. It's because the A.P.A., a private guild, one with extensive ties to the drug industry, owns the naming rights to our pain. That so significant a public trust is in private hands, and on such questionable grounds, is what we ought to worry about.
Gary Greenberg's new book, "The Book of Woe: The DSM and the Unmaking of Psychiatry," will be published in May. Illustration by Richard McGuire.

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When the fifth edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders hits the stores on May 22nd, it will signal the end of a fraught thirteen-year campaign. Every revision of the D.S.M. causes controversy; that's what happens when experts argue in public about the nature of human suffering.

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(Jenoa Briar-Bonpane, personal communication, March 22nd, 2015).

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(Jenoa Briar-Bonpane, personal communication, March 22nd, 2015).

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We could spend an entire semester or two studying the DSM.  Instead, we just touch on it here.  The DSM is something you are likely to work with either directly or indirectly in social work.  In order for clients to access counseling, treatment, financial assistance, etc., they need to qualify and that often means having the right diagnosis.  The DSM is a taxonomy of diagnoses.  It provides names and numbers for symptoms that allow us to use a kind of universal language/code to communicate with other disciplines/institutions about the types of challenges clients are living with.  The DSM does not explain causes, nor does it offer solutions.  It is a catalog created by a handful of mental health clinicians and it changes over time reflecting the influence of historical, political, and theoretical contexts of the time.  It is a tool we are wise to be familiar with and one we also need to review with a critical eye for what is included, what is missed, and who/how decided what conditions/symptoms are deemed pathological.

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"The ritual of making a diagnosis is a performance that occurs within the social space." (Datta 2014)
There is a lot written about the DSM, I choose this article by Datta, as he describes the DSM and how they created the diagnosis of homosexuality and how it was sort of but not really removed.

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41 years ago this month, homosexuality ceased to be a mental illness. Amid growing opposition from gay activists, and dissent within its own ranks, the American Psychiatric Association was begrudgingly forced to expunge homosexuality from the DSM-II. Paradigmatic of the social nature of psychiatric diagnosis, the purging of homosexuality from the psychiatric nomenclature highlights the instability of the psychiatric sign: once signifying disease and perversion, homosexuality came to be recognized by the establishment as a normal variant of human sexuality. The 'coming out' of homosexuality from the DSM-II allows us to reflect on the following: (1) change in the concept of mental disorder is slow; (2) diagnosis-making is a social act; (3) the construct of illness and disorder, 'mental' or otherwise is a social one; (4) the construct of illness has social consequences; and (5) shifts in the concept and nature of disorder reflect wider social, political and economic forces more than scientific advancement.
The slow demise of homosexuality as disease
Although the removal of homosexuality from the DSM is often heralded as a radical and rapid sea-change in how sexual orientation was viewed, the reality is more sobering. Homosexuality was not actually removed from the diagnostic nomenclature of the revised DSM-II. Instead, it was shifted into parentheses of the new diagnosis of sexual orientation disturbance. The change in diagnosis was supposed to create as little disruption to psychiatric practice as possible, and the position statement about this change notes that 'hardly anyone can disagree' that 'Modern methods of treatment enable a significant proportion of homosexuals who wish to change their sexual orientation to do so.' While noting that homosexuality does not fulfill criteria for a psychiatric disorder, the same position statement goes on to note "no doubt, homosexual activists will claim that psychiatry has at last recognized that homosexuality is as "normal" as heterosexuality. They will be wrong." The same year, 1973, a number of publications discuss diagnostic and treatment aspects of homosexuality, including aversive conditioning, use of electric shocks and even lobotomy. Further, the diagnosis of 'sexual orientation disturbance', later to become 'ego-dystonic sexual orientation' was only applicable to same-sex attraction. The implicit assumption is that it is not possible for those with opposite-sex attraction to feel negatively about this. Whether true or not, the assumption goes unchallenged.

It was not until 1987 that homosexuality completely disappeared from the DSM, but the concept of ego-dystonic sexual orientation persists in the World Health Organization's International Classification of Diseases. More recently we have seen a similar shift with transgendered individuals. It is interesting to note as homosexuality came out of the DSM, transsexualism was making its debut. This transformed into gender identity disorder, and most recently, to gender dysphoria in DSM-5.
Diagnosis making as a social act
The ritual of making a diagnosis is a performance that occurs within the social space. Making a diagnosis, as Arthur Kleinman has pointed out, is a semiotic act. It involves transforming experiences into 'symptoms' and 'signs' that signify disease or disorder. These diagnoses confer social meaning not just for those labeled so, but also come to signify what it means to be without disease or disorder. Taking the example of homosexuality, its appearance as a social and medical concept at the end of the 19 th century, also coincided with the invention of heterosexuality. Psychiatry was thus instrumental in creating and polarizing sexual identities in a way that persists today despite the demedicalization of sexual orientation. Diagnoses thus convey not only information about the treatability and prognosis of particular states, they also create identities, confer recognition, or conversely erode personhood, and our ability to construct meaningful narratives beyond the medico-psychological discourse. Schizophrenia is not just a diagnosis, but signifies a particular identity that shifts with cultural convenience - once capturing the attractive delicate white woman who has been trampled by society, to the imposing, aggressive black man who poses a threat to social order.
The social construction of 'mental illness'
Whilst the concept of the sodomite dates back to biblical times, the concept of the homosexual did not emerge until the late 19 th century. At once, sexual behaviors were transformed into a diagnosis and a sexual identity. That this transformation occurred when it did is no accident, but accompanied the tacit acceptance that sex was not simply procreative but pleasurable, the increasing prominence of the physician-as-expert, and the need for physicians to 'prescribe a healthy sexuality.' Similarly, the demise of homosexuality as disorder came at a time when pleasure could be celebrated over duty, with the rise of anti-authoritarianism, and psychiatry's grand venture into solving the social ills of our time. Whether homosexuality or psychosis have some biological basis does not detract from the role of psychiatrists as agents of social control. For example, in 1972, just a year before the DSM expunged homosexuality, John Feighner and colleagues proposed diagnostic criteria for various mental disorders to be used in research. Among the '14 psychiatric illnesses' was homosexuality, defined so:

1. This diagnosis is made when there are persistent homosexual experiences beyond 18 (equivalent of Kinsey 3 to 6)

2. Patients who fulfill the criteria for transsexualism are excluded

3. Patients who perform homosexual activity only when incarcerated for a period of at least one year without access to members of the opposite sex are excluded

Here we see a psychiatric definition of homosexuality that is operational and wholly arbitrary, with the long-term incarcerated given a free ticket to buggery, unencumbered by psychiatric labeling. All medical diagnoses psychiatric or otherwise are socially constructed, but psychiatric illnesses also confer identities - wanted or unwanted - that other medical illnesses seldom do.
The social consequences of illness
Illnesses can be stigmatizing, and although such diseases including leprosy, TB, cancer, and AIDS have carried stigma for sufferers at some point in history, they rarely alter the experience of the self in the way that psychiatric diagnoses do. The pathologization of homosexuality convinced some individuals that they were sick, and that in itself may have made them (feel) sick! The removal of homosexuality from the psychiatric canon has undoubtedly facilitated the rights of those who identify as lesbian, gay, or bisexual. Adoption rights, same-sex marriage, the repeal of Don't Ask Don't Tell would never have occurred if homosexuality continued to be seen as the developmental end-point of deep psychopathology. In the same way, diagnoses of mental illness confer individuals with a sense of otherness, that they are somehow different than other people, perhaps less important, less deserving, or of less worth. With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them. Despite public education campaigns (or perhaps because of them), the stigma of mental illness is as enduring as it was 50 years ago.
The rise of illness: scientific advancement or commercial cash cow?
As discussed above, the removal of homosexuality from the DSM was the result of sociopolitical forces, and not a reflection of scientific advancement. Even within psychiatry, the mass proliferation of psychiatric diagnoses is viewed as something commercial. Up until the 1970s psychiatric diagnoses were not necessary to treat individuals with a wide range of problems, and psychiatrists had little competition from other mental health professionals. With the growth of clinical psychology and other mental health professions who could provide psychotherapy more cheaply, psychiatrists needed to maintain their moral authority over the mental life that had come under their purview. What psychiatrists, as physicians, could do that others could not was make diagnoses. Thus the medical profession created new diagnoses for the range of mental life that psychiatrists were already seeing in their offices; and these became the signifiers that these patients had a medical illness that required treatment. The growth of psychopharmacology allowed the boundaries for these new diagnoses to expand, creating new markets, not only for the pharmaceutical industry but also for the mental health field. There was no problem too small to warrant pharmaceutical relief.

But what of the social and political forces that facilitated the growth of mental illness? At the same time that homosexuality was losing its status as mental disorder, the US was in the midst of a deepening economic crisis. By 1980, the year of publication of DSM-III, a new republican government headed by Ronald Regan entered the White House. Rather than draw attention to the psychiatric casualties that would amass under neoliberal policies, it became convenient to locate mental illness within the self - in brain, cell, and molecule - rather than as a product of community, society, and state. It is for this reason that psychiatrist Joanna Moncrieff has suggested that a "marriage of convenience" exists between biopsychiatry and the politics of neoliberalism. A biological model that was gaining ascendance was fortified by the political expedience of supporting a paradigm of psychic discontent that obfuscated the wider social, economic and political forces at play. In the same way the removal of homosexuality from the DSM was not the result of scientific advancement but political will, the solidifying of disease status of minor psychiatric diagnoses and their biological basis are more the result of these same forces than scientific triumphalism.
Further Reading

1. Disturbance: Proposed Change in DSM-II, 6th Printing Page 44 Position Statement. http://dsm.psychiatryonline.org/data/PDFS/dsm-ii_homosexuality_revision.pdf (accessed 12/24/13)

2. Freund K, Langevin R, Cibiri S, Zajac Y. Heterosexual Aversion in homosexual males. Br J Psychiatry 1973; 122:163-169

3. McConaghy N, Barr RF. Classical, avoidance and backward conditioning treatments of homosexuality. Br J Psychiatry 1973; 122:151-162

4. Rhodes RJ. Homosexual aversion therapy. Electric shock technique. J Kans Med Soc 1973; 74:103-105

5. Freeman W. Sexual behavior and fertility after frontal lobotomy. Biol Psychiatry 1973; 6:97-104

6. MacDonal AP Jr., Huggins J, Young S, Swanson RA. Attitudes towards homosexuality: preservation of sex morality or the double standard? J Consult Clin Psychol 1973; 40:161

7. Lesse S. The current confusion over homosexuality. American Journal of psychotherapy 1973; 27:151-154

8. Stoller RJ, Marmor J, Bieber I, Gold R, Socarides CW, Green R, Spitzer RL. A Symposium: should homosexuality be in the APA nomenclature. Am J Psychiatry 1973; 130:1207-1216

9. Maletzky BM, George FS. The treatment of homosexuality by 'assisted' covert sensitization. Behav Res Therapy 1973; 11:655-657

10. American Psychiatric Association. Homosexuality and Sexual Orientation

11. Feighner JP, Robins E, Guze SB, Woodruff RA, Winokur G, Munoz R. Diagnostic Criteria for Psychiatric Research. Arch Gen Psychiatry 1972; 26:57-62

12. Ch.3 The Fall and Rise of Homosexuality. pp55-99 In: Kutchins H, Kirk SA. Making Us Crazy: DSM: The Psychiatric Bible and the Creation of Mental Disorders. New York: The Free Press, 1997

13. Katz JN. Ch.7 the invention of heterosexuality. Pp83-98 In: Privilege: a reader.

14. Tanner BA. Shock intensity and fear of shock in the modification of homosexual behavior in males by avoidance learning. Behav Res Therapy 1973; 11:213-218

15. Skene RA. Construct shift in the treatment of a case of homosexuality. Br J Med Psychol 1973; 46:287-292

16. Moncrieff J. Neoliberalism and biopsychiatry: a marriage of convenience. In: Cohen C, Timimi S. (Eds.) Liberatory Psychiatry. p235-257 Cambridge: Cambridge University Press, 2008

The Psychopathology of American Life: A British physician explores how the concept of mental disorder has vastly expanded over the past century, reporting from the front lines of American psychiatry.

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When Homosexuality Came Out (of the DSM) - Mad In America

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With a diagnosis of schizophrenia, if internalized, comes the erosion of personhood, lowered self-esteem, shattered dreams, and a sense of disenchantment. The psychiatrist Richard Warner has even suggested that those who reject the diagnosis of severe mental illness may have better outcomes as they retain the right to construct their own narrative of personhood and define what really matters for them.

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Erikson, V., Kress, V. (2005).  Beyond the DSM Story: Ethical Quandries, Challenges, and Best Practices. Sage Publishers

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Erikson, V., Kress, V. (2005).  Beyond the DSM Story: Ethical Quandries, Challenges, and Best Practices. Sage Publishers

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Chapter 5

Toward Resolving the Quandaries and Pursuing Ethical and Contextually Sensitive Diagnostic Practice

This chapter focuses specifically on identifying Thirty-Three Activities that helps practitioners increase their awareness of the ethical dilemmas inherent in using the DSM. It also helps increase competence in contextually sensitive and thorough assessment practices. I will go ahead and list the Thirty Three activities and their goals which I believe are necessary as practitioners to practice and embrace. Each activity goes into a number of exercises in order to reach that goal, I will not list the exercises here but highly recommend checking them out at some point.

ACTIVITIES 1 through 33

Activity 1

Goal: To encourage empathy with client perspectives on diagnostic labeling. To reduce the tendency for detachment from and objectification of the client when applying diagnostic labels.

Activity 2

Goal: To increase awareness about common perceptions of mental illness and to explore the roots and sustainers of negative perceptions.

Activity 3

Goal: To increase an understanding of the political nature of some DSM diagnoses by exploring who promoted the inclusion of the diagnoses, and what their reasons might have been for wanting the diagnoses included.

Activity 4

Goal: To develop an appreciation of the idea that diagnoses are not set "facts," but context ridden, ever-changing labels (e.g., at one point, the DSM labeled gays and lesbiansas mentally ill). To become aware of the ever changing line between what is normal or abnormal behavior.

Activity 5

Goal: To encourage awareness of and sensitivity to the complexity of the diagnostic decision-making processes.

Activity 6

Goal: To encourage multiplistic and divergent thinking about the DSM and its uses.

Activity 7

Goal: To encourage considering (or adding) alternative explanations for client' experiences beyond a "mental disorder" conceptualization. To help practitioners view diagnoses as a case and situation specific. To facilitate an emphasis on client strengths.

Activity 8

Goal: To facilitate and practice deconstructing clients' language in order to understand clients' perceptions of their reality, rather than merely "accepting" the language and assuming that one knows what the clients mean.

Activity 9

Goal: To avoid making premature diagnostic decisions, as research illustrates that delaying diagnostic decisions leads to greater accuracy, and that once made, practitioners find it quite difficult to shift their diagnostic impressions despite new information.

Activity 10

Goal: To encourage the consideration of strengths and how they can be used and emphasized in counseling.

Activity 11

Goal: To explore the numerous issues and layers of considerations that contribute to diagnostic decision making, and to encourage advanced levels of conceptualization and thinking about diagnoses.

Activity 12

Goal: To increase practitioners' awareness of the impact of culture on the diagnostic process. To broaden the perspective of culture and beyond race into other cultural experiences.

Activity 13

Goal: To explore the issues of gender as they relate to conceptions of normal and abnormal behavior. To identify value influences on what is included or not included in the DSM.

Activity 14

Goal: To explore social constructions of gender related to normal and abnormal behavior.

Activity 15

Goal: To consider the sociopolitical contect associated with past diagnoses.

Activity 16

Goal: To explore the role that gender and culture play in conceptualizing mental disorders

Activity 17

Goal: To foster an ability to use strength base language that communicates an understanding of the impact of context. To decrease pathology-based language during client assessment.

Activity 18

Goal: To explore the importance of cultural context in the etiology and treatment of mental disorders.

Activity 19

Goal: To use case studies to explore ethical and practical issues associated with the DSM

Activity 20

Goal: To increase the ability to collaborate, involve clients in the diagnostic process, and facilitate the formation of diagnostic meanings.

Activity 21

Goal: To encourage understanding of the ways that values may impact counseling and diagnosis

Activity 22

Goal: To increase practitioners' understanding of the values inherent in different theoretical approaches and how they compare with those of the DSM.

Activity 23

Goal: To encourage understanding of the relationship between values of certain mental health professions and the values inherent in the DSM diagnositic manual.

Activity 24

Goal: To increase awareness of the more positive perspectives of diagnostic labels, and thus to reduce the chance that professionals will fail to identify client strenths when assessing.

Activity 25

Goal: To encourage divergent way of thinking about diagnoses.

Activity 26

Goal: This exercise challenges the linearity of causation that is assumed in the DSM and in the medical model upon which it is grounded, and instead, posits a circular or recursive way of understanding causes of problems.

Activity 27

Goal: To encourage consideration of alternative methods of diagnosis and counter the notion that disorders should be conceptualized as being located solely in the individual.

Activity 28

Goal: To help practitioners to consider a dimensional versus a categorical perspective on diagnosis

Activity 29

Goal: To externalize clients' diagnosis and internalize personal agency.

Activity 30

Goal:To imagine possible funding sources or methods of payment other than insurance

Activity 31

Goal: To increase awareness of the benefits that mental health professionals have to offer beyond traditionally reimbursed services.

Activity 32

Goal: To increase awareness of the value to employers of mental health provider's knowledge.

Activity 33

Goal: To increase mental health providers' ability to advocate for and market themselves.

WOW RIGHT ON!

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This is the newest and latest addition of the DSM. This video explains the continued controversy.

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The Diagnostic and Statistical Manual (DSM) 5 Controversy

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The Diagnostic and Statistical Manual of Mental Disorders is one of the most important books in Western society and indeed in most of the countries of the world. It defines the difference between normal and abnormal. It specifies how to diagnosis a mental disorder and whether or not a mental problem is actually a disorder or not.

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Book

Erikson, V., Kress, V. (2005). Beyond the DSM Story: Ethical Quandries, Challenges, and Best Practices. Sage PublishersRobbins, S., Chatterjee, P., Canda, E. (2012) Contemporary Human Behavior Theory: A Critical Perspective for Social Work. Allyn & Bacon.

Articles online

Datta, Vivek (2014) When Homosexuality Came out of the DSM. Mad in America Science, Psychiatry and Community, Featured Blog. Retrieved from http://www.madinamerica.com/2014/12/homosexuality-came-dsm/

Greenberg, Gary (2013) The D.S.M and the Nature of Disease. The New Yorker. Retrieved from http://www.newyorker.com/tech/elements/the-d-s-m-and-the-nature-of-disease

Juvenile Bipolar Research Foundation (2015) JBRF Website.
Retrieved from http://www.jbrf.org/page-for-families/the-diagnostic-and-statistical-manual-of-mental-disorders-dsm/

YouTube

Bullying News Videos. (2008, September 13). Classical Conditioning: Ivan Pavlov Retrieved from https://www.youtube.com/watch?v=hhqumfpxuzI

The Curious Classroom.  (2013, August 30).  Bandura and Social Learning Theory.  Retrieved from https://www.youtube.com/watch?v=NjTxQy_U3ac&t=108

The Curious Classroom.  (2013, December 22).  Social Psychological Theories of Aggression – Social Learning Theory.  Retrieved from https://www.youtube.com/watch?v=EnWocJQ1U30

The Diagnostic and Statistical Manual (DSM) 5 Controversy. (2014, January 5th)
Retrieved from https://www.youtube.com/watch?v=n27YaehttLc

Fuse Universal.  (2011, Februarys 16).  What is Social Learning?  Retrieved from https://www.youtube.com/watch?v=NIlwGYY0_AA

JustUsSeven. (2010, October 3). Learning To Do ABA Therapy at Home. Retrieved from https://www.youtube.com/watch?v=Lbins7IVf4Y

Learning for the 21st Century. (2012, December 30). Use a Learning Theory: Behaviorism. Retrieved from https://www.youtube.com/watch?v=KYDYzR-ZWRQ

TedX Talks. (2013, April 26). Change Behavior- Change the World: Joseph Grenny at TEDxBYU. Retrieved from https://www.youtube.com/watch?v=6T9TYz5Uxl0&index=2&list=PLes-2vkbjh_CINIGM1r4VxTyq30o-bSsB