Conclusions
There is a song in the Broadway musical (and movie) called West Side Story. The song is called “Dear Sergeant Krubske” and it is sung by a bunch of “juvenile delinquents” who are commenting on the many diagnoses that have been assigned to their behavior. One of the delinquents (Action) lets Sergeant Krubske know that they are “psycholgic’ly disturbed” because of their parent’s pathology. Diesel subsequently suggests that they should be taken to a “headshriker”. The psychiatrist, however, determines that it is a sociological problem. “Society’s played [them] a terrible trick.” So, these “punks” have a “social disease” and need to be seen by a social worker. However, the social worker determines that these delinquents are just lazy and “deep down inside” they are no good! So how do we diagnosis the “mental illness” that inflicts these young men and results in bad behavior? What should be done with them? Therapy? Disciplinary action? Jail? Is this not also the case with a DSM diagnosis that is detached from a broader environmental and societal assessment?
In this essay, we have been operating a bit like the juvenile delinquents in West Side Story. We have been questioning the labels assigned to people in our society who are declared “mentally ill.” While there are many benefits to be found in the use of DSM as a diagnostic tool, there is much more to be done in the broader assessment of psychopathy. In essence. we have just provided the first draft of a broad-based assessment of DSM and its past and present use.
In providing this first draft, we have identified some of the initial broader based assessment questions to be asked. In the next essay, we move from this broad-based landscape rendering to a more intimate portrait of DSM as it is actually perceived and used by clinical practitioners around the world. We hope that the landscape rendering along with the portrait moves us to a clearer understanding of and appreciation for the strengths and weakness associated with the assumptive worlds of psychopathy.
