Social Work and the DSM: A Qualitative Examination of Opinions

Abstract

Social work has had an irresolute association with the Diagnostic and Statistical Manual of Mental Disorders (DSM), and it has been suggested that social workers have been a relatively silent majority when it comes to critiques of the DSM. This study examined social workers’ attitudes towards the DSM via semi-structured interviews completed with twenty experienced social workers. Data revealed both ambivalence and unease in relation to what the DSM represents sufficient to suggest that social workers might be encouraged collectively to champion a new method of assessment that is more congruent with the mission of social work.

KEYWORDS:

• Diagnostic and Statistical Manual of Mental Disorders (DSM)
• ethics
• assessment
• medicalization
• medical model
• mission of social work

Notes

1. ¹ To demonstrate whether and how social workers’ opinions and use of the DSM have changed over time, the results of this study were compared to the results of Kutchins’ and Kirk’s 1988 project, upon which this study was partially modeled. In contrast to Kutchins’ and Kirk’s participants, the majority of whom more emphatically rejected the use of the DSM, the majority of this study’s participants were more ambivalent toward the DSM. Unlike Kutchins’ and Kirk’s participants, who expressed an overall doubt that biological factors are related to psychological phenomena, participants in this study were more at ease with the medical model. Also, whereas Kutchins’ and Kirk’s participants had reservations about the clinical usefulness of the DSM, the majority of this study’s participants found the DSM to have clinical utility, especially when they were engaged in treatment planning, analyzing behavior, determining prognoses and communicating with other professionals. Conversely, compared to Kutchins’ and Kirk’s participants, the social workers in this study were more aware of the problems that can occur for clients when they are assessed via the DSM. They feared that the DSM places too much emphasis on pathology, can lead to inappropriate treatment, detracts from in-depth understanding of clients’ problems and obscures individual differences. Kutchins’ and Kirk’s participants were less concerned about these potential dilemmas, perhaps because the DSM was newly introduced into the assessment process at the time of their study and these social workers had not yet experienced any major repercussions from its use first hand.