In chapter 18, the authors question the cultural validity of diagnosing multicultural clients. What do the authors conclude about the issue? Do you agree with the authors? Why or why not?minimum 400 word APA format
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560
Section
Four
.
Multicultural Conceptualization
European heritage and may be in conflict with North American laws (McGoldrick, Giordano,
& Garcia-Preto, 2005). If this thinking is extended to other areas of diversity, we might ask,
how can we understand gender? Sexual orientation? Religion? How can a counselor fully
understand the challenges of being an immigrant if he or she is not an immigrant? Can counselors ever completely eliminate the influence of systemic oppressions-such as institutional.
ized racism and sexism-on themselves, the client, or relationships when diagnosing people
who differ from the majority (Bhugra & Kalra, 2010X In what forum might counselors disouss
the ‘oillness” or diagnosis of contexts or systems? How do counselors find funding for correcting “i11” systems, rather than expecting clients to correct systemic oppressions that may be
contributing to or exacerbating problem issues?
Questions about counselors’ cultural and gender sensitivity are not the only questions
raised by those pursuing culturally sensitive diagnosis and case conceptualization. The usefulness of the various editions of the Diagnostic and Statistical Manual of Mental Disorders
(DSM published by the American Psychiatric Association has been challenged for people
who differ from the dominant culture. Critics ask whether counselors can draw any definite
conclusions about women, people of color, or those who are gay, lesbian, or transgender based
on a diagnostic system and psychological testing system whose development was grounded in
the knowledge of European American men and on evidence from research studies that did not
include diverse participants (LaRoche et a1., 2015).
Some may wonder whether any counseling or diagnostic system can be free of such
potential bias and problems, which is a legitimate ethical qr”ry
that counselors
“oriidering
are called to “recognize historical and social prejudices in the misdiagnosis
and pathologizing
of certain individuals and groups” (ACA, 2074,p.11). It is important to recognize that the
DSM or any particular diagnostic, assessment, or counseling system can only be considered
one assessment method among many. However, no diagnosis contains the whole or absolute
“truth” about the problem issues. From this perspective, counselors might consider learning
the terminology of the DSM-S to position themselves as advocates for their clients.
Cultural Validity in Assessment
Cultural validity is another important diagnostic concern. It is widely believed that ignoring
the importance of cultural differences when diagnosing and assessing individuals from diverse
backgrounds can lead to unfair and unethical testing practices and diagnoses (de1 Rosario
Basterra, Trumbull, & Solano-Flores, 2010). For example, the wording, illustrations, layout,
and contextual information embedded in diagnostic questioning reflect the language, ways of
thinking, and experiences of a particular cultural group. It is likely that some diagnoses and
test items might privilege individuals from one cultural group and penalize individuals from
other cultural groups (Canino & Alegria,2008). To consider fully the cultural aspects of
diagnostic assessment, it is important to take a step back and consider recent fundamental
to the DSM system.
The fifth edition of DSM (APA, 2013) has significantly affected the way counselors
diagnose mental disorders by moving away from the categorical, axial system to dimensional
assessments. A categorical classification approach works best when members of a diagnostic
changes
class are homogeneous and there arc clear boundaries between diagnostic categories; however,
this has not always been the case for certain DSM categorical diagnoses, with many frequently
overlapping and having a high co-occurrence (i.e., comorbidity, the presence of multiple diag-
noses
or pathologies within the same individual). For example, depressive disorders are
9 €Il-
Chapter 1g
.
Multiculturai DiagnosiS and
Concep tualization 561
strongly linked with anxiety
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562
Section
Four
.
Multiculturai Conceptualization
contextual factors, environmental factors; del Rosario Basterra et a1.,20I0), whether through the
CtrI or not. While the CtrI and dimensionalization are welcome changes, the limitations of any
emerging measures as well as the potential harm done to clients if they are used inappropriately
must be understood. Overall, assessment powerfully influences clinical decisions, particularly
those related to decisions about what is “normal” or “abnomal.”
NORMAL VERSUS ABNORMAL
Fundamental to any diagnostic process are questions abor-rt wl.rere tl-re line should be drzuurn
betr,r,een normal and abnormal. Relatedly. who gets to drauv the lir-re’l Who gets to decide rvhat
is abnormal? On r’vhat basis do they get to decide these things? At rvhat point do we decide that
a person is mentally ill? In ansrver to questions like these, some anthors assert that people in
power rnahe these decisions and that agreements about those decisions change over time.
depending on who is in power and the spirit olthe times (Williams,2015). Williams further
argued that economics also encroach on what is nclrmal and r,vhat is treatable. since increasing
the number of rein.rbr”rrsable diagnoses increases the treatment domain and profits of rner.rtai
health providers. Consequently, “problems in living,” such as worrying, leeling blue, havin-g
obsessive thoughts, bearing grudges, lackir-rg sexual interest, not sleepir-rg, smoking, being alone.
havin-e tr”ouble in school, and being hung over. may be moved into the reahn of cliagnosable urental
illness or patl,ology (Wilcoxon. Magnuson.
& Norem, 2008), u’hich is particrilarly troubling.
For example. the recently added diagnosis ol disruptive mood dysregulatior-r disorder
(DMDD), marked by severe, recllrrent outbursts o1’temper. either verbal or behavioral. that
are disproportionate in intensity and cluration with situational factors and developmental
level (APA,20l3), has beer.r ar”gued to r.r-rerely demonstrate typical childhood behavior
(Copeland. Angold, Costello, & Egger:, 2013). Copeland et al. (2013) indicatecl that DMDD is
uncommonly forind after childhood” and it also tencls to co-occnr with another disorcler 6l’
to 920/,, of the time. The merits ol this cliagnosis aside. there is an additional socio-cultr-rral
consideration regarding DMDD: aff-ected children have been found to live in poverty and
experience difficr.rlties r.vith social supports. Il a client’s context is not accurately considered.
s,v-mptomatology ma-v result in a DMDD misdia-enosis. when the behavior n-ray actually be tl-re
result of nor”mative adaptation to a child’s environmcut.
As another exampie ol nonnal problems in living. consider the changes made to the
DSM-5 regarding depressior-r and bereavement. Grief reactiolrs rnay. depending on cultural
context. closely resemble depression. In the DSIV-5, the bereavement exclusion tor zr diagnosis
of major depressive clisorder was removed. In other words, il a person now meets the critelia
lbr major depression, he or she cor.rld be diagnosed with n-raior depression even if he or she is
grieving. Some argr-re that by changing direction iu this lvay, the DSM system pathologizes the
rrormal reaction to a universal human experience: the deatl-r of a lovecl one (Fox & Jones.
2013). Contrary to this belief. Kendler (2010) argued that individuals who experience other li1e
stressors areiust as likely to develop a major depressive disorder as those mourning the cleath
ol a loved one. Despite this argument, the potential to pathologize what could be a normal
grief reaction is wortl-ry of consideration by culturally sensitive clinicians.
Gender dysphoria is another ne\,. controversial diagnosis that replaces the previously
tenr,ed ger-rder identity disorder (APA, 2013). By removirrg the term “disorder,” the new dia-snosis may reduce tl-re stigrna experienced when a clier-rt identifies with a gender other than his or
her birth gender. Though this diagnosis n.ra.v be argued as continued pathologizing of an evermore-accepted variation of the human condition in the European-Americar cultural context.
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