Woolfe, R., Strawbridge, S., Douglas, B. & Dryden, W. (2009). Handbook of Counselling Psychology, 3.ed. London: SAGE. Del I, II og IV.
Diagnoses is made from historical and cultural frameworks.
In DSM-IV diagnoses is described as in the person, which is the perspective of the medical model. Counselling psychology sees the diagnose as something that occurs in the interaction between people. Despite that DSM only tries to describe the diagnoses, the DSM is historical and cultural specific and therefore it is theory-driven.
The diagnose-systems started in the beginning of the 1900s when Kreapelin diagnosed patient from a two-axis system, with manic depression on the first axis and dementia preacox on the other. Meyer created a more social based perspective on mental disorders in DSM-I and DSM-II, but it was not until the DSM-III that the biological psychiatry influenced the diagnoses in DSM. This wave was called neo-kreapelinism.
You can view a diagnose like a coin, it is made of some kind of metal (the biology of the human) but the worth of it is socially created.
What can you use a diagnose for? To group and communicate, but it is best used for science. Practical psychologist find that it doesn’t fit for the problems that clients have, there is a lot of comorbidity and double diagnoses as well as coping problems for the clients (the sickness-role ect.). The client is labelled with a diagnose and it becomes what the person is.
Despite that the clarity of the mental disorders in the society is hidden away by the industrialisation it is still a societal problem.
Borderline symptoms can be compared with the society’s tendencies during the cold war. Where the psychologist watches Borderline as based on transferentiale relations, the psychiatrist watches Borderline from the perspectives of psychopathological traits of the patient.
Borderline can be seen as s personality structure. The personality was seen as something individual, stabile and independent, but is presently seen as something developing over time, which is consistent with the fact that many Borderline patient reminisces over time.
With this personality perspective Borderline becomes a reaction to the intersubjective relational experiences that influences the identity and self of the person. An example of this kind of experiences could be abuse.
Self-harm (cutting etc.) is a part of many diagnoses and many self-harming people meet the demands for a Borderline diagnose for example. Self-harm begins often in adolescence and is primarily conducted by girls. To let blood out is historically been performed always. It has been a way to communicate with gods, a treatment method and is now watched as a symptom for a mental disorder. Al this is culturally determined. There is hereby difference between the medical model and the subjective experience.