COUC 546 Week 1 DB Forum 1 Example

Discussion Board Forum 1: Thread and Replies

COUC 546 Psychopathology, Discussion Board Forum 1 (thread and two replies)

Thread by [Student Name]

The prompt, the writer's background and the classmates' posts are composites standing in for the course's own forum; the manual, textbooks, Scripture and studies are real and described from their published sources; the requirements follow Liberty's public course guide for COUC 546.

Thread

When I worked as a probation officer, one man on my caseload told me that his late grandmother visited him at night to warn him about trouble. My supervisor wanted a psychiatric referral. His family, recent immigrants from Haiti, saw nothing unusual in it. That case has stayed with me for years, and this week's reading finally gave me tools to think about it clearly.

The DSM-5 describes a mental disorder, in my paraphrase, as a clinically significant disturbance in thinking, emotion regulation or behavior that reflects a dysfunction in the processes underlying mental functioning and that usually brings significant distress or disability (American Psychiatric Association, 2013). Just as important are the exclusions: an expectable or culturally approved response to a common loss is not a disorder, and neither is behavior that is simply socially deviant or in conflict with society unless it results from a dysfunction in the person.

Wakefield (1992) explains why such a definition always needs both science and judgment. He argued that a disorder is a harmful dysfunction: "dysfunction" is a factual claim that some mental mechanism is failing to do what it was designed to do, while "harmful" is a value judgment based on social standards. Kring et al. (2016) similarly present abnormality as a combination of criteria, such as distress, disability and violation of norms, none of which is sufficient alone.

Culture enters at both points. What counts as harm depends on social values, and what looks like dysfunction may be a culturally shared experience. The manual's glossary of cultural concepts of distress acknowledges this, and the Cultural Formulation Interview gives clinicians a way to ask about it. In a field trial across six countries, 318 patients and 75 clinicians found the interview feasible, acceptable and useful, and clinicians' initial doubts about its feasibility eased after they had used it once (Lewis-Fernández et al., 2017).

For counselors, the lesson is that a diagnosis is a judgment we make about a person in context, not a label we read off a list of symptoms. In my probationer's case, I would now ask how his family and community understood the visits, whether they caused him distress or impairment, and what he himself wanted help with, before deciding whether any referral was needed.

Proverbs 18:13 calls it folly to give an answer before hearing the matter out (English Standard Version Bible, 2001/2016). Listening first is a safeguard against mislabeling a person.

Classmates: have you seen a case where culture changed how a symptom should be understood?

Reply to Rachel

Rachel, you asked whether intense grief after a parent's death should ever be diagnosed, since grieving people can look depressed for months. The manual's definition speaks directly to this. It excludes expectable or culturally approved responses to a common stressor or loss, such as the death of a loved one, from the category of mental disorder (American Psychiatric Association, 2013). At the same time, DSM-5 removed the old bereavement exclusion for major depression, which means that a major depressive episode can be diagnosed even after a loss when its full criteria are met, using clinical judgment about what is typical for the person and their culture.

The framework proposed by Wakefield (1992) helps here. Grief is painful, so it is harmful in an everyday sense, but it is the expected functioning of the human attachment system, not a dysfunction. A diagnosis becomes reasonable when something beyond normal grief appears, such as pervasive worthlessness or an inability to function long after cultural norms would expect. For counselors, the challenge is to support grieving clients without pathologizing them while staying alert to depression that grief can hide. Cultural norms matter here too, since mourning periods and expressions of grief differ widely between communities. How would you tell the difference in a first session?

Reply to Samuel

Samuel, you wrote that clients who describe hearing God's voice in prayer might be misdiagnosed by counselors unfamiliar with their faith tradition. I agree, and it fits the cultural material in this module. Before calling an experience a symptom, the manual asks clinicians to find out whether the person's own religious or cultural community regards it as normal (American Psychiatric Association, 2013). A charismatic Christian who hears God speak during worship, with no distress or impairment, is in a very different position from someone hearing hostile voices that disrupt sleep and work.

The Cultural Formulation Interview gives counselors a structured way to explore this. In the six-country field trial, patients and clinicians considered it acceptable and useful (Lewis-Fernández et al., 2017), which suggests clients do not find questions about their beliefs intrusive when they are asked respectfully. In practice, I would ask how the client's congregation understands the experience, whether it brings comfort or fear, and whether anything about it has changed recently, such as its frequency or tone. Asking the client's pastor or a trusted member of the congregation, with consent, could also help. Do you think counselors who share a client's faith are more or less likely to miss a real problem?

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Kring, A. M., Johnson, S. L., Davison, G. C., & Neale, J. M. (2016). Abnormal psychology: The science and treatment of psychological disorders (13th ed.). Wiley.

Lewis-Fernández, R., Aggarwal, N. K., Lam, P. C., Galfalvy, H., Weiss, M. G., Kirmayer, L. J., Paralikar, V., Deshpande, S. N., Díaz, E., Nicasio, A. V., Boiler, M., Alarcón, R. D., Rohlof, H., Groen, S., van Dijk, R. C. J., Jadhav, S., Sarmukaddam, S., Ndetei, D., Scalco, M. Z., ... Vega-Dienstmaier, J. M. (2017). Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial. British Journal of Psychiatry, 210(4), 290-297. https://doi.org/10.1192/bjp.bp.116.193862

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47(3), 373-388. https://doi.org/10.1037/0003-066X.47.3.373