American Psychological Association Mental health diagnostic categories are woven into our culture in a pervasive and possibly limiting pattern. Call someone paranoid or schizzy and everyone knows or think they know what it means. In the forensic arena diagnostic categories are frequently a part of litigation. In that arena, diagnostic labels are reified and seen as clear, powerful causal factors in many circumstances and for many purposes. There is little perception or awareness of the murky and controversial nature of diagnosis. Even among mental health professionals, there is little understanding of diagnosis, what it is, and what level of validity and reliability specific diagnostic categories possess. Social workers with no training and no understanding of taxonomic considerations make diagnoses confidently and testify without ever being questioned about their competency to make diagnosis. Psychiatrists who, with most physicians, have little awareness of the nature of causality assert, without any hesitation or doubt, diagnoses based on clinical observations and clinical judgment. Psychologists often use inappropriate tests with questionable psychometric qualifications and produce diagnoses based on them that may not be solidly supported by reliable data. Nevertheless, the DSM-IV is regarded and accepted as the Bible of diagnosis and its diagnostic categories are treated as if they were revealed and infallible truth. Put that reality together with the research findings that show most diagnoses are made within 30 seconds to three minutes of meeting an individual1 and that once made, mental health professionals cling to their swift diagnostic conclusion in the face of disconfirming data.2 This presents a compelling case for the necessity of much greater sophistication and knowledge of diagnosis. This book is a well written, well organized, and persuasive treatment of diagnosis and the problems in making accurate diagnostic conclusions. The history of the growth of the DSM categories is traced together with an analysis of the process by which what was a small 128-page book in the 1950s now is a full sized 800+ pages. The criticisms of DSM-IV are presented cogently in several chapters, and suggestions are made about possible better and more accurate ways to reach diagnostic conclusions. Every mental health professional who must deal with diagnosis in whatever fashion must carefully study and read this book. To do less is to accept a level of incompetence and poor practice that can result in untold harm done to many individuals. Reviewed by Ralph Underwager, PhD,, Institute for Psychological Therapies. 1 Gauron, E. F., & Dickinson, J. K. (1969). The influence of seeing the patient first on diagnostic decision making in psychiatry. American Journal of Psychiatry, 126(2),85-91. 2 Arkes, H. R. , & Harkness, A. R.
(1980). Effects of making a diagnosis on subsequent Gale, J., & Marsden, P., (1982). Clinical problem solving: The beginning of the process. Medical Education, 16,2 2-26.
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