"What are the ethics of getting a diagnosis, or conceptualization of a problem, entirely wrong and then treating it for years,despite new information, and despite the doubts of the patient?" 1. Diagnosis in this field is based on clinical presentation. Do the symptoms observed match those listed in the DSM? If we are "diagnosing," then we must use the DSM. 2. Conceptualization of a problem. This is not a synonym for diagnosis. A conceptualization is subjective. If it is entirely subjective, how can it be wrong? "Entirely wrong?" Since you brought up diagnosis, I'll ask. Is the true problem a vastly different diagnosis, such as panic disorder vs. schizophrenia, or something more similar, such as dysthymia vs. MDD? 3. "Treating it for years." How, what treatment? How does the treatment provided differ from that which would be provided for what you believe is the true diagnosis? Sometimes treating any problem for "years" could be considered unethical. 4. "despite the doubts of the patient." Your previous postings have implied that you believe the patient is not at all responsible for any part of his/her therapy. What doubts? I have seen many patients who don't want to believe they are schizophrenic, for example, and denial of alcoholism is common in that population. Please do not become defensive and accuse me of blaming, but why did the patient not assert him/herself? What are the doubts? Doubts about the dianosis? About the treatment? In practice, most therapists don't look at a diagnosis and perform some specific therapy. They work from a treatment plan, individualized for each patient. That treatment plan was devised with the patient's input and consent. You could ask the question of any professional. For example if your left foot hurts and your doctor diagnoses you with a wrist ache, and you were given pain relievers, what is the harm. And that's the ultimate question here: how was the patient harmed?
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