Abstract
White supremacist applications of the Diagnostic and Statistical Manual of Mental Disorders (DSM) result in the disproportionate labeling of Black, Indigenous, and People of Color as violent or severely mentally ill. Racial diagnostic disparities and misdiagnoses are endemic in social work practice, in part because of the DSM’s categorical classification system, which encourages reductive thinking and reinforces implicit racial biases. While courses on psychopathology are common requirements for clinical field placements, the mental health field’s reliance on the DSM often contradicts antiracist curricula. In an effort to address this paradox, we utilize pedagogical approaches that seek to critique and deconstruct White Supremacist applications of the DSM while simultaneously preparing students to enter a field that relies so heavily on diagnostic labels. This is done in part by teaching students to shirk the DSM’s categorical perspective in favor of a transdiagnostic perspective—identifying symptoms or traits underlying human suffering that occur across diagnostic categories and are informed by macro systems of privilege and oppression. Teaching students to adopt a transdiagnostic perspective may disrupt White Supremacist practices in diagnostics by encouraging an acknowledgement of multisystem factors underlying human suffering without relying on discrete diagnostic categories that are prone to racial interpretations.
Highlights
The Influence of the DSM on the Classification of Psychological DisordersThe developmental history of the DSM, as well as the appropriateness of its fit within the social work profession (Lyter & Lyter, 2012), is rife with controversy given its increasing focus on biomedical and socially decontextualized perspectives of psychological disorders (see Bredström, 2019; La Roche et al, 2015; Whooley, 2014)
White supremacist applications of the Diagnostic and Statistical Manual of Mental Disorders (DSM) result in the disproportionate labeling of Black, Indigenous, and People of Color as violent or severely mentally ill
Children of color are more likely to be diagnosed with oppositional defiant disorder for symptoms that result in attentiondeficit hyperactivity disorder diagnoses in White children (Ballentine, 2019). Such racial diagnostic disparities are endemic in social work practice, in part because of the categorical classification system of the DSM, which encourages reductive thinking, reinforces implicit racial biases in a primarily White workforce, and supports a false dichotomy between micro and macro practice
Summary
The developmental history of the DSM, as well as the appropriateness of its fit within the social work profession (Lyter & Lyter, 2012), is rife with controversy given its increasing focus on biomedical and socially decontextualized perspectives of psychological disorders (see Bredström, 2019; La Roche et al, 2015; Whooley, 2014) Despite these controversies, social work practitioners, educators, and researchers have been tasked with utilizing the DSM in their practices while balancing its biomedical approach with strengths-based and socioecological perspectives (Probst, 2013). Integrating a dimensional approach into the DSM-5—that is, assessing symptoms on a spectrum versus using criterion thresholds—was the initial goal of DSM-5 reviewers, as they believed doing so would elucidate biological etiologies of mental distress (Whooley, 2014) Such a change would have reinforced the appropriateness of adopting a transdiagnostic perspective in assessment given the substantial overlap in diagnostic categories.
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