A Critical Look at Clinical Psychology The DSM “Patchwork of scientific data, cultural values, political compromises, and the material for making insurance claims” The 1980 edition revision tried to mimic a biomedicine style In Psychiatric diagnosis, etiology is rarely known Reliability remains a big problem The 1980 edition began to define conditions by listing symptoms. Revision was an effort to portray psychiatry as a branch of medicine which would boost credibility of the field and ensure financial viability. However in biomedicine, diagnosis are based on etiology > that is causes rather than symptoms. And they would then test for various causes of said symptoms. In psychiatric diagnosis, etiology, is rarely known. Ex. Schizophrenia (combination of things). Reliability remains a big problem with the DSM. Just because not every clinician may give the same individual the same diagnosis. -> could be due to cultural values, ethnicity or socioeconomic status. Homosexuality Multiple theories that classified homosexuality as a disease Psychiatrist and psychoanalyst Edmund Bergler infamously wrote in a book for general audiences, “I have no bias against homosexuals; for me they are sick people requiring medical help... Still, though I have no bias, I would say: Homosexuals are essentially disagreeable people, regardless of their pleasant or unpleasant outward manner... [their] shell is a mixture of superciliousness, fake aggression, and whimpering. Like all psychic masochists, they are subservient when confronted with a stronger person, merciless when in power, unscrupulous about trampling on a weaker person” On December 15, 1973, the Board of Directors of the APA declassified homosexuality per se as a mental disorder from the DSM-II Judgements of Normality depend on social norms, cultural standards and local customs. Grief is another example. Talk about different cultures Commercial for Cymbalta Questions to ask after Video: What are some things that you noticed within the video? What are the explicit ideas expressed in this video? What’s the overall message? Political Economy of Clinical Psychology 1980’s revision involved “medicalization” Adoption of the language of medicine. Including terms like: disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis. Introduction of managed care Intrusion of pharmaceutical companies Conflict of interest between pharmaceutical companies and psychiatrists Drastic cuts in funds for mental health care The 1980 revision of the DSM involved medicalization. Meaning they adopted the language of medicine to understand and describe psychological suffering. This language would include disease, symptoms, patient, syndrome, relapse, diagnosis and prognosis.So now that the field of psychiatry identified itself as a “medical” specialty, the research efforts concentrated on searching for biological bases of suffering and pharmaceutical treatments. Politica.

1. A Critical Look at Clinical Psychology
The DSM
“Patchwork of scientific data, cultural values, political
compromises, and the material for making insurance claims”
The 1980 edition revision tried to mimic a biomedicine style
In Psychiatric diagnosis, etiology is rarely known
Reliability remains a big problem
The 1980 edition began to define conditions by listing
symptoms. Revision was an effort to portray psychiatry as a
branch of medicine which would boost credibility of the field
and ensure financial viability. However in biomedicine,
diagnosis are based on etiology > that is causes rather than
symptoms. And they would then test for various causes of said
symptoms. In psychiatric diagnosis, etiology, is rarely known.
Ex. Schizophrenia (combination of things). Reliability remains

2. a big problem with the DSM. Just because not every clinician
may give the same individual the same diagnosis. -> could be
due to cultural values, ethnicity or socioeconomic status.
Homosexuality
Multiple theories that classified homosexuality as a disease
Psychiatrist and psychoanalyst Edmund Bergler infamously
wrote in a book for general audiences, “I have no bias against
homosexuals; for me they are sick people requiring medical
help... Still, though I have no bias, I would say: Homosexuals
are essentially disagreeable people, regardless of their pleasant
or unpleasant outward manner... [their] shell is a mixture of
superciliousness, fake aggression, and whimpering. Like all
psychic masochists, they are subservient when confronted with
a stronger person, merciless when in power, unscrupulous about
trampling on a weaker person”
On December 15, 1973, the Board of Directors of the APA
declassified homosexuality per se as a mental disorder from the
DSM-II
Judgements of Normality depend on social norms, cultural
standards and local customs. Grief is another example. Talk
about different cultures
Commercial for Cymbalta
Questions to ask after Video:
What are some things that you noticed within the video?
What are the explicit ideas expressed in this video?

3. What’s the overall message?
Political Economy of Clinical Psychology
1980’s revision involved “medicalization”
Adoption of the language of medicine. Including terms like:
disease, symptoms, patient, syndrome, relapse, diagnosis and
prognosis.
Introduction of managed care
Intrusion of pharmaceutical companies
Conflict of interest between pharmaceutical companies and
psychiatrists
Drastic cuts in funds for mental health care
The 1980 revision of the DSM involved medicalization.
Meaning they adopted the language of medicine to understand
and describe psychological suffering. This language would
include disease, symptoms, patient, syndrome, relapse,
diagnosis and prognosis.So now that the field of psychiatry
identified itself as a “medical” specialty, the research efforts
concentrated on searching for biological bases of suffering and
pharmaceutical treatments. Political and economic changes
affect clinical psychology and how therapists work. For
example, the introduction of managed care, a system created to
contain treatment costs. These organizations promote mental
health treatments that are brief, routinized and cheap; relies on
medication. Therapists have protested over this form of
treatment, complaining that it forces them to give clients
inadequate or ineffective forms of treatment.
Then we see the intrusion of pharmaceutical companies. The
sale of psychiatric medication has grown. 10 percent of women

4. and 4% of males in the US take antidepressant drugs. Between
3-5% of children in the US take Ritalin, for ADD. There has
been many debates on advertisements used to market these
medications. Most believe that these ads are shaping the way we
view these drugs, mental illness and psychotherapy -> ex. these
drugs could discourage people from attending psychotherapy
sessions.
Critics have also pointed out how the relationship between
psychiatry and the pharmaceutical companies have compromised
the field. Some even speculate that there are financial ties
between drug companies and the psychiatrists who compiled the
DSM 4.
Then we have the drastic cuts in federal and state funds for
mental health care. Many people from impoverished
backgrounds and minority groups, who depend on this health
care, have ended up homeless or in prison. There are more
mentally ill people in prison in the US than in mental hospitals.
They receive little to no mental health care and often their
conditions worsen in prison.
Sex for our Pleasure or Profit?
Reframing of sexual activities as psychiatric or medical
conditions plays into the hands of pharmaceutical companies to
market their products.
Female sexual dysfunction
First, a long history of social and political control of sexual
expression created reservoirs of shame and ignorance that make
it difficult for many people to understand sexual satisfaction or
cope with sexual problems in rational ways.
Second, popular culture has greatly inflated public expectations
about sexual function and the importance of sex to personal and
relationship satisfaction.

5. First, a long history of social and political control of sexual
expression created reservoirs of shame and ignorance that make
it difficult for many people to understand sexual satisfaction or
cope with sexual problems in rational ways.
Second, popular culture has greatly inflated public expectations
about sexual function and the importance of sex to personal and
relationship satisfaction.
Questions:
Lacked interest in having sex
Were unable to come to climax
Came to climax too quickly
Experienced physical pain during intercourse
Did not find sex pleasurable even if sex was not painful
Felt anxious just before having sex
Had trouble lubricating

6. Diffusion of Deficit
The tendency to label everyday unhappiness, ordinary
shortcoming, and personal quirks as pathological.
Gives social power to the mental health professions.
Anxiety, Sadness, Grief, Hyperactivity, Fear, Difficulty
learning certain subjects.
When common actions are translated into a professionalized
language of mental deficit and this language is disseminated,
the culture comes to construct itself in these terms. This leads
to an enhanced dependency on the professions, which are
forced, in turn, to invent additional terms of mental deficit.
Thus, virtually all remaining patterns of action stand vulnerable
to deficit translation.When common actions are translated into a
professionalized language of mental deficit and this language is
disseminated, the culture comes to construct itself in these
terms. This leads to an enhanced dependency on the professions,
which are forced, in turn, to invent additional terms of mental
deficit. Thus, virtually all remaining patterns of action stand
vulnerable to deficit translation.
Focus on the Individual
Often Psychotherapies focus on fixing what’s wrong within an

7. individual
Less focus on environmental factors contributing to disorder
Examples:
PTSD
Marriage
Often psychotherapies focus on determining what is wrong
within the individual and that there is something internal that
needs to be addressed. They focus more so on trying to help the
clients adjust to their circumstances rather than trying to
transform the circumstances that may be contributing to the
problem.
An example used in the textbook was PTSD or post-traumatic
stress disorder. This disorder was basically used to explain the
difficulties some Vietnam veterans had after returning from the
war. Key characteristics of the disorder was witnessing or
perpetrating death which tied into the horrific experiences of
these veterans. But as the mental health profession shifted,
researchers began to ask if neurological and genetic factors
contribute to PTSD and possible childhood precursors of PTSD.
This shifts interests away from war experiences and towards
vulnerabilities “inside” the individual.
Another example used in the book was marriage counseling.
Most therapist believe that there is nothing wrong with the
institution of marriage but rather there is something wrong with
the particular couple within the marriage. However, In our
society, the concept of marriage is often exaggerated and
portrayed in movies as being perfect or superficial. So these
unrealistic expectations can affect the institution of marriage,

8. meaning the problem may not lie specifically in a particular
marriage but the concept of marriage may be flawed.
What Does Gender Have to Do with This?
Questions to Ask:
How do you think gender effects clinical psychology? How do
you think gender affects how people are diagnosed?
Do you think gender plays a role in diagnosis? Do you think
gender played a role in 1980’s? Do you think gender plays a
role today?
Gender: History of Hysteria
Greek word “Hysterikos” meaning uterus
Women in the 19th Century
Sigmund Freud and female sexuality
The Case of Dora
It was very common for women to be diagnosed as suffering
from hysteria. Hysteria comes from the greek word
“Hysterikos” meaning of the womb, uterus, or suffering of the
womb. Hysteria has had a long history of being documented as
an illness. Plato believed that the uterus was an animal and that

9. it moved around, causing strange symptoms in the body.
Symptoms usually differed from patient to patient but some
common symptoms were shortness of breath, heaviness in the
abdomen, muscular spasms and fainting. Anxiety and unusual
behavior also contributed to the illness.
Women in the 19th century were believed to be more emotional,
dependent and gentle by nature. This perception made many
people believe that women were more susceptible to illness.
With so little power and control, depression and stress was
common for women struggling to cope with the strict gender
roles of that era.
Freud believed that hysteria was rooted in unconscious conflicts
or problems within patient’s sexual life. The case of Dora was a
popular case conducted by Freud and revolving around the
concept of hysteria. So, basically Dora was being sexually
harassed by her father’s friend and instead of believing his
daughter, her father and Freud claimed she had an illness that
stemmed from her arousal and disguised sexual desire to be with
either her father or his friend. This illness Hysteria was just an
attempt to promote the values of that time and to regard women
who opposed those values as being insane.
Gender in Clinical Psychology
Women more likely to be diagnosed with depression and anxiety
Men more likely to be diagnosed with antisocial disorder or
substance abuse
Gender roles

10. Studies have shown that women are more likely to be diagnosed
with depression, anxiety disorders and eating disorders. While
men are more likely to be diagnosed as antisocial, bipolar and
suffering from substance abuse. But why? Is it because men
have been socialized to express stress through anger or acting
out? Is it because women have been socialized to express stress
through dysphoria?
Gender roles are still relevant in our society today. Women are
subjected to certain “ideal” beauty standards and this is
expressed in the younger age groups. In a recent survey of 1300
females age 7-21, 60% of 11-16 year olds wear makeup to
school and 40% wear padded bras. Among 7-11 year olds, 50%
use makeup and wear high heels. A third of them reported being
unhappy with their looks and the number rose to 50% once they
hit the age of 16. Many of the girls reported they experienced
sexual harassment. Around 1 in four of the 16-18 age group
admitted they were unhappy -> which fits many of the studies
showing that in the teenage years girls outnumber boys in rates
of depression and anxiety.
Pressures created by the multiple roles women play and gender
discrimination account for women’s poor mental health
What does Socioeconomic Status Have to Do with This?
Questions to ask:
Do you think socioeconomic status dictates how a person with a
mental disorder with be treated? Do you think that people with
low socioeconomic status recieve the same treatment or the
same diagnosis as people from low socioeconomic status? Why

11. not?
Social Status in Clinical Psychology
The relation between psychiatric diagnosis to social power
Upper Class & Power
Examples:
Drapetomania
Kleptomania
Atypical Theft Offender Disorder
In regards to social status, certain groups of people are entitled
to certain privileges. The same type of discrimination appears in
some forms of clinical diagnosis. For example, before the
emancipation of slaves in the US, the diagnosis of drapetomania
was given to explain the slaves’ uncontrollable urge to escape
from slavery. This promoted the ideals of that time and served
the purposes of the ones in power, the slave owners.
Another example would be kleptomania which is the irresistible
urge to shoplift. This diagnosis was created around the same
time as the creation of large department stores. Even though
people of all social classes stole, the authorities distinguished
between criminal acts of theft and acts reflecting mental illness
based on social class. Ordinary women were considered thieves
and upper-class women were diagnosed with a mental disorder.
The diagnosis of Kleptomania was used as a shield to protect
upper-class women and promote a sense of superiority.
Wionna Ryder, who was apprehended in 2001 for shoplifting,
was given a mental illness diagnosis of Atypical Theft Offender

12. Disorder (not included in the DSM). Mental health professionals
argued that she wasn’t a criminal but suffering from a mental
illness due to emotional stress. Which ties into this idea of
diagnosis being used to promote the interests of those in power
or in high status.
How does cultural and societal values affect Clinical
Psychology?
Questions to ask:
How does our society shape the way Clinical psychology is
practiced? How does our culture or society shape the way
mental disorders are viewed? Do you think our societal values
are present in the way the DSM is structured?
Normality v. Abnormality
Judgements of normality and abnormality depend on cultural
standards, social norms and local customs
Homosexuality
Cultural Distinctions
Does Middle-class white North Americans = Normal?
Judgements of normality and abnormality depend on cultural
standards, social norms and local customs. Prior to 1980,

13. homosexuality was considered a mental disorder and included in
the DSM. This category served to promote the cultural and
moral values against homosexuality. Clinicals in the US are
trained to distinguish between normal “grief” and clinical
depression according to the length of time since the death of the
loved one. However, the customary mourning period is several
months longer in other countries compared to the US. Clinicians
following these customs may misdiagnosis someone as being
depressed. Some countries even find communication with the
deceased, thus talking to the dead or hearing voices may not be
unusual to them but for most americans this would cause alarm
for a mental illness.
The criteria for mental illness put forward in the DSM may
reflect the values and customs of white, middle-class North
Americans. Since in most studies, where clinicians are
researching what is normal and abnormal, most participants are
middle-class and white.
How Can We Make a Change?
Questions to ask:
What are some solutions to the problem with clinical
psychology?
Alternatives to Psychotherapy
Narrative Therapy: helping families and individuals to
challenge and revise problem-focused narratives and to generate
new narratives that open the way toward positive change.
Family Therapy

14. Community psychology: seeking to understand and challenge
the sociopolitical causes of psychological suffering such as:
urban poverty, economic marginalization, racial injustice,
substance abuse, etc.
Example of community psychology: workers may help
communities to reconstitute and strengthen themselves by
sponsoring programmes of reconciliation and conflict resolution
by assisting them in rebuilding civil society organizations or by
strengthening local governance.
So these forms of therapy are shifting the attention from the
individual and onto factors that may contribute to the disorder.