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Lecturer challenges DSM and diagnosis models
Posted Friday, October 14, 2011 3:40 PM
 
EVENT
 
On September 29, visiting professor of psychology and psychiatry Brian Iwata (University of Florida) delivered a lecture challenging diagnosis of behavioural disorders. Iwata developed the first model for conducting functional (experimental) analyses of problem behavior, which is regarded as the standard in the field for both clinical research and best practice.

This year’s Samuel Weiner Distinguished Visitor talk was titled “Experimental Approaches to Behavioral Assessment: Rebirth of the Medical Model?”



***

When professor of psychology and psychiatry Brian Iwata was a student in the 1970s, the medical model was starting to be considered suspect and ineffectual.

Instead, popular anti-psychiatry criticisms, such as Thomas Szaz’s infamous 1961 text The Myth of Mental Illness, argued that mental illness was a convenient “social construct” that identified people’s “problems in living” in pathological terms. Meanwhile, B. F. Skinner’s work on behavioural analysis and the idea of behaviour as a function of its consequences was replacing the medical model. All of it added up to the influential idea that mental illness was nothing more than a deviation from a socially-constructed and defined “norm,” a sort of trap to label and discipline those who were different.

Then Iwata accepted a post-doc position at Johns Hopkins University in Baltimore, and everything changed. As he puts it, he “landed right in the medical model.”

Surrounded by medical practitioners and immersed in an environment of cutting-edge medical knowledge, Iwata started to attend medical lectures and learn about the medical model.

He learned about the foundations of medicine and science and the tradition of “experimental medicine” that goes back to Claude Bernard’s classic 1865 text An Introduction to the Study of Experimental Medicine. Based on the premise that “observation informs, experimentation teaches,” experimental medicine goes beyond mere observation of symptoms to include experimental hypothesizing, testing and analysis under controlled conditions.

Then, while running the post-doc training program at Johns Hopkins, Iwata was referred a patient from a pediatrics office with the instruction to “rule out psychogenic seizures” (i.e., seizures effected by psychological causes).

Iwata had no idea what to do. Rather than think about theories of socially-constructed behaviour, Iwata was suddenly expected to provide a real-life diagnosis based on his presumed expertise of behavioural analysis.

He sought help and found it when a neurologist he worked with told him, “You know, you reinforcement guys, you know how to do that: You just rule out certain diagnoses when you take away certain [positive or negative] reinforcements.”

Suddenly Iwata found himself applying behavioural analysis in controlled experiments in order to rule out or isolate specific causes, descriptions and diagnoses. This also led to the possibility for intervention.

Iwata is now renowned for his innovative applications of behavioural analysis to the field of developmental disabilities, and especially for his work with the environmental conditions — including psychosomatic factors — for self-injurious behaviour.

U of M’s Javier Virués Ortega, assistant professor in psychology, noted in his introduction to Iwata’s lecture that the implications of Iwata’s work for mental illness and other neurological disorders are far-reaching —both in diagnostic and interventative terms. Virués Ortega is currently collaborating with Iwata to apply this approach in such areas as dementia and autism.

As Iwata contended in his lecture, the possibilities for applications of a behavioural-analysis approach are almost limitless, particularly in the field of mental illness and behavioural disorders. He challenged the current “proof of pudding” criteria used in diagnosis of psychiatric disorders, echoing other criticisms of the psychiatric “bible,” the DSM, or Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association.

The DSM has undergone four major revisions since its initial publication in 1952, with the fifth edition scheduled to be released in May 2013. The categorical classification system has been criticized in terms of its scientific validity, the medicalization of behaviour and its exploitation for drug intervention, its seemingly arbitrary lines between normal and “abnormal,” and its focus on surface symptoms rather than underlying causes.

Presenting his work on self-injurious behaviour disorders, Iwata illustrated how an “experimental lens” could be used to diagnose — and potentially treat — such disorders through behavioural analysis and environmental interventions.
 
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